PMID- 32798202
OWN - NLM
STAT- MEDLINE
DCOM- 20210701
LR  - 20210701
IS  - 1538-9375 (Electronic)
IS  - 1525-8610 (Linking)
VI  - 22
IP  - 4
DP  - 2021 Apr
TI  - Post-Acute and Long-Term Care Patients Account for a Disproportionately High 
      Number of Adverse Events in the Emergency Department.
PG  - 907-912.e1
LID - S1525-8610(20)30565-X [pii]
LID - 10.1016/j.jamda.2020.06.043 [doi]
AB  - OBJECTIVES: High rates of adverse events (AEs) are reported for post-acute and 
      long-term care settings (PA/LTC: skilled nursing facilities, inpatient 
      rehabilitation centers, long-term acute care facilities, and home health). 
      However, emergency department (ED)-based studies in this area are lacking. We 
      describe all-cause harm among patients from PA/LTC settings seen in the ED. 
      DESIGN: Retrospective observational study using the ED Trigger Tool, with dual 
      independent nurse reviews of 5582 ED records with triggers (findings increasing 
      the likelihood of an AE) and confirmatory physician review of putative AEs. 
      SETTING AND PARTICIPANTS: We captured data for all adult patients at an urban, 
      academic ED over a 13-month period (92,859 visits). PA/LTC patients were 
      identified using a computerized ED Trigger Tool and manual review (kappa = 0.85). 
      MEASURES: We characterize the AEs identified by severity and type using the ED 
      Taxonomy of Adverse Events, and whether the AE occurred in the ED or was present 
      on arrival. We estimate population AE rates using inverse probability weighting. 
      RESULTS: Compared with non-PA/LTC patients, PA/LTC patients (4.4% of population; 
      8.2% of our sample) tended to be older (median age 69 vs 50 years), with 
      comparable sex ratios (54% female overall). PA/LTC patients accounted for 21% of 
      all AEs (26% present on arrival; 13% in ED). Rates of AEs occurring in the ED 
      were comparable after matching on age. Present on arrival AEs from a PA/LTC 
      setting were most commonly related to patient care (39%), medication (34%), and 
      infections (16%). CONCLUSIONS AND IMPLICATIONS: PA/LTC patients account for a 
      small proportion of ED visits but experience a disproportionate number of AEs 
      that are primarily present on arrival and patient-care related, and contribute to 
      an admission rate double that for non-PA/LTC patients. Arguably, this cohort 
      represents PA/LTC patients with the most severe AEs. Understanding these AEs may 
      help identify high-yield targets for quality improvement.
CI  - Copyright (c) 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine. 
      Published by Elsevier Inc. All rights reserved.
FAU - Griffey, Richard T
AU  - Griffey RT
AD  - Department of Emergency Medicine, Washington University School of Medicine, St. 
      Louis, MO, USA; Department of Psychiatry, Washington University School of 
      Medicine, St. Louis, MO, USA. Electronic address: griffeyr@wustl.edu.
FAU - Schneider, Ryan M
AU  - Schneider RM
AD  - Department of Emergency Medicine, Washington University School of Medicine, St. 
      Louis, MO, USA; Department of Psychiatry, Washington University School of 
      Medicine, St. Louis, MO, USA.
FAU - Adler, Lee
AU  - Adler L
AD  - Department of Medicine, University of South Florida, Orlando, FL, USA; Office of 
      Clinical Effectiveness, AdventHealth, Altamonte Springs, FL, USA.
FAU - Todorov, Alexandre
AU  - Todorov A
AD  - Department of Emergency Medicine, Washington University School of Medicine, St. 
      Louis, MO, USA; Department of Psychiatry, Washington University School of 
      Medicine, St. Louis, MO, USA.
LA  - eng
GR  - R18 HS025052/HS/AHRQ HHS/United States
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, P.H.S.
DEP - 20200811
PL  - United States
TA  - J Am Med Dir Assoc
JT  - Journal of the American Medical Directors Association
JID - 100893243
SB  - IM
CIN - J Am Med Dir Assoc. 2021 Apr;22(4):899-900. PMID: 33832713
MH  - Adult
MH  - Aged
MH  - Cohort Studies
MH  - *Emergency Service, Hospital
MH  - Female
MH  - Humans
MH  - *Long-Term Care
MH  - Male
MH  - Quality Improvement
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Adverse events
OT  - emergency
OT  - post-acute care
OT  - trigger tool
EDAT- 2020/08/17 06:00
MHDA- 2021/07/02 06:00
CRDT- 2020/08/17 06:00
PHST- 2020/03/13 00:00 [received]
PHST- 2020/06/16 00:00 [revised]
PHST- 2020/06/22 00:00 [accepted]
PHST- 2020/08/17 06:00 [pubmed]
PHST- 2021/07/02 06:00 [medline]
PHST- 2020/08/17 06:00 [entrez]
AID - S1525-8610(20)30565-X [pii]
AID - 10.1016/j.jamda.2020.06.043 [doi]
PST - ppublish
SO  - J Am Med Dir Assoc. 2021 Apr;22(4):907-912.e1. doi: 10.1016/j.jamda.2020.06.043. 
      Epub 2020 Aug 11.