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Jentien Vermeulen, M.D., of the University of Amsterdam and colleagues in the United States analyzed a random sample of 4,371 charts from 14 inpatient psychiatric units at acute care general hospitals in urban and rural Pennsylvania. Rates of adverse events and medical errors were calculated overall, then stratified by patient and hospital factors.
The following were categorized as adverse events: self-harm or injury, adverse drug event, assault, sexual contact, patient fall, and “other.” Medical errors included any mention in the chart of medication errors, elopement (when a patient leaves the facility without authorization), possession of contraband, and other nonmedication errors.
Adverse events were identified in 14.5% of hospitalizations, and medical errors were identified in 9.0%. Factors associated with a lower risk of an adverse events or medical errors were being aged 31 to 42, having private insurance, and being treated at high-volume hospitals (defined as between 1,061 and 1,280 admissions annually).
Factors associated with a higher risk of adverse events or medical errors were being aged 54 or older, admitted during the weekend, admitted to a rural hospital, and treated at very-high-volume hospitals (more than 1,280 admissions a year). Patients over 54, who accounted for 23.9% of all adverse events, were more than twice as likely to experience an adverse event compared with patients aged 18 to 30 (11.5%).
Regarding the higher risk for very high-volume hospitals, Vermeulen and colleagues noted that “operating at overcapacity and with higher patient-to-nurse ratios are factors known to be associated with an increase in rates of patient safety events.” In contrast, “smaller hospitals may be under-resourced. ... The optimal equilibrium of staffing and resources to provide safe care may be present in high-volume hospitals.”
They noted that in general medicine, research has established a framework to lower rates of preventable harm in five steps: measurement of events and errors, development of evidence-based care practices, investment in implementing safety plans, local hospital ownership and peer learning, and alignment of efforts around common goals and measures.
“The field of mental health care would do well to adopt a similar framework,” they continued. “From our findings, we can then move to the next step and develop evidence-based practices that address the specific vulnerabilities to patient safety in inpatient psychiatry. … These interventions should be targeted to patient groups with the highest risk of experiencing a patient safety event.”
For related information on patient safety, see the Psychiatric News article “Ensuring Patient, Staff Safety Begins With Supportive Management, Staff Training.”
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