BACKGROUND AND PURPOSE:

• Eldridge et al. (JAMA, 2022) determined the change in the rates of adverse events in hospitalized patients from 2010 to 2019

METHODS:

• Serial cross-sectional study
  • Data from the Medicare Patient Safety Monitoring System (MPSMS) from 2010 to 2019
• Population
  • Sampling of adult patients hospitalized in US acute care hospitals
  • Condition groups from 2010 to 2019
    • Acute myocardial infarction
    • Heart failure
    • Pneumonia
    • Major surgical procedures
  • Condition groups from 2012 to 2019
    • All other conditions
• Study design
  • Adverse events abstracted from medical records
  • Includes 21 measures across 4 adverse event domains
    • Adverse drug events
    • Hospital-acquired infections
    • Adverse events after a procedure
    • General adverse events (hospital-acquired pressure ulcers and falls)
• Primary outcome
  • Total change over time for the observed and risk-adjusted adverse event rates in the subpopulations

RESULTS:

• 244,542 hospitalized patients | 3156 US acute care hospitals
  • 4 condition-based groups
    • Mean age 68.0 (SD, 15.9) years | 52.6% female
  • All other conditions
    • Mean age 57.7 (SD, 20.7) years | 59.8% female
• From 2010 to 2019, the following changes in adverse events occurred
  • A decrease in acute myocardial infarction
    • 2010: 218 events per 1000 discharges
    • 2019: 139 events per 1000 discharges
  • A decrease in heart failure
    • 2010: 168 events per 1000 discharges
    • 2019: 116 events per 1000 discharges
  • A decrease in pneumonia
    • 2010: 195 events per 1000 discharges
    • 2019: 119 events per 1000 discharges
  • A decrease in major surgical procedures
    • 2010: 204 events per 1000 discharges
    • 2019: 130 events per 1000 discharges
  • No change in all other conditions
    • 2012: 70 events per 1000 discharges
    • 2019: 70 events per 1000 discharges
• After adjustment for patient and hospital characteristics, the annual change in all adverse events per 1000 discharges was
  • Acute myocardial infarction: Relative risk (RR) 0.94 (95% CI, 0.93 to 0.94)
  • Heart failure: RR 0.95 (95% CI, 0.94 to 0.96)
  • Pneumonia: RR 0.94 (95% CI, 0.93 to 0.95)
  • Major surgical procedures: RR 0.93 (95% CI, 0.92 to 0.94)
  • All other conditions: RR 0.97 (95% CI, 0.96 to 0.99)
• The risk-adjusted adverse event rates declined significantly in all patient groups for
  • Adverse drug events
  • Hospital-acquired infections
  • General adverse events
• For patients in the major surgical procedures group, the risk-adjusted rates of events after a procedure declined significantly

CONCLUSION:

• Between 2010 and 2019, there were significant decreases in adverse events reported in hospitalized patients with acute myocardial infarction, heart failure, pneumonia, and major surgical procedures
• There was also a reduction in adverse events between 2012 and 2019 for patients admitted for all other conditions
• Further research is needed to determine whether these trends represent a significant change in patient safety
• The authors state

The lower overall rate of decline in adverse event rates in the all other conditions group, compared with the acute myocardial infarction, heart failure, pneumonia, and major surgical procedures groups, might be due to the quality improvement efforts targeted at the latter 4 conditions, whereas similar interventions did not occur for most of the conditions represented in the all other conditions group

Learn More – Primary Sources:

Trends in Adverse Event Rates in Hospitalized Patients, 2010-2019

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