PMID- 28118693 OWN - NLM STAT- MEDLINE DCOM- 20171031 LR - 20171031 IS - 1742-6723 (Electronic) IS - 1742-6723 (Linking) VI - 29 IP - 2 DP - 2017 Apr TI - Case-control study to investigate variables associated with incidents and adverse events in the emergency department. PG - 149-157 LID - 10.1111/1742-6723.12736 [doi] AB - OBJECTIVE: To detect and analyse incidents (Is) and adverse events (AEs) in the ED. We hypothesised that I/AE are associated with patient load. METHODS: We undertook a case-control study in a tertiary level hospital ED (from 1 April 2012 to 31 March 2013). Three percent of patients were randomly selected and screened for I/AEs. I/AEs were adjudicated by consensus of four FACEMs. Controls were matched to cases 2:1. Logistic regression was used to analyse the data. RESULTS: We sampled 2167 patients. After exclusions, 217 I/AEs were detected and analysed. The I and AE rates were 6.0 and 4.1%, respectively. The serious AE rate was 0.8% and 30 day mortality was 0.1%. Diagnostic error occurred in 3.7% of all patients and adverse drug reactions in 2.5%. Seventy-seven percent of the I/AEs were judged preventable. ED occupancy of <35 patients was the reference group. Compared with this group, if 36-40 or 41-45 patients were in the ED, I/AEs were more likely to occur (odds ratio [OR] 2.37 [95% confidence interval (CI) 1.40-4.01, P < 0.0] and 1.8 [95% CI 1.03-3.15, P = 0.04], respectively) but not when there were >46 patients (OR 1.7, 95% CI 1.0-3.1). Higher hospital occupancy (90-99%) was a protective factor for sustaining an I/AE (OR 0.57, 95% CI 0.35-0.92, P = 0.02). CONCLUSION: I/AEs are common in the ED and a large proportion is preventable. Strategies for prevention are required. The relationship with patient load needs further clarification, since our data suggests increased I/AE rates with higher occupancy but not highest occupancy. CI - (c) 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine. FAU - Hendrie, Jamie AU - Hendrie J AD - Department of Emergency Medicine, Austin Health, Melbourne, Victoria, Australia. FAU - Yeoh, Michael AU - Yeoh M AD - Department of Emergency Medicine, Austin Health, Melbourne, Victoria, Australia. FAU - Richardson, Jo AU - Richardson J AD - Department of Emergency Medicine, Austin Health, Melbourne, Victoria, Australia. FAU - Blunt, Andrew AU - Blunt A AD - Department of Emergency Medicine, Austin Health, Melbourne, Victoria, Australia. FAU - Davey, Peter AU - Davey P AD - Clinical Information Analysis and Reporting, Austin Health, Melbourne, Victoria, Australia. FAU - Taylor, David AU - Taylor D AUID- ORCID: 0000-0002-8986-9997 AD - Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia. FAU - Ugoni, Antony AU - Ugoni A AD - Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia. LA - eng PT - Journal Article DEP - 20170124 PL - Australia TA - Emerg Med Australas JT - Emergency medicine Australasia : EMA JID - 101199824 SB - IM MH - Adult MH - Aged MH - Case-Control Studies MH - Diagnostic Errors/statistics & numerical data/*trends MH - Drug-Related Side Effects and Adverse Reactions MH - Emergency Service, Hospital/organization & administration/*statistics & numerical data MH - Female MH - Humans MH - Logistic Models MH - Male MH - Medication Errors/statistics & numerical data/*trends MH - Middle Aged MH - Multivariate Analysis MH - Odds Ratio OTO - NOTNLM OT - diagnostic error OT - drug-related side-effects and adverse drug reaction OT - emergency service hospital OT - human OT - medical error EDAT- 2017/01/25 06:00 MHDA- 2017/11/01 06:00 CRDT- 2017/01/25 06:00 PHST- 2015/12/09 00:00 [received] PHST- 2016/11/20 00:00 [revised] PHST- 2016/12/02 00:00 [accepted] PHST- 2017/01/25 06:00 [pubmed] PHST- 2017/11/01 06:00 [medline] PHST- 2017/01/25 06:00 [entrez] AID - 10.1111/1742-6723.12736 [doi] PST - ppublish SO - Emerg Med Australas. 2017 Apr;29(2):149-157. doi: 10.1111/1742-6723.12736. Epub 2017 Jan 24.