Inappropriate hospital admission as a risk factor for the subsequent development of adverse events: a cross-sectional study

Background All health overuse implies an unnecessary risk of patients suffering adverse events (AEs). However, this hypothesis has not been corroborated by direct estimates for inappropriate hospital admission (IHA). The objectives of the study were the following: (1) to analyze the association betw...

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Published in:	BMC medicine Vol. 21; no. 1; pp. 1 - 312
Main Authors:	San Jose-Saras, Diego, Vicente-Guijarro, Jorge, Sousa, Paulo, Moreno-Nunez, Paloma, Aranaz-Andres, Jesús María, Pérez, Cristina Díaz-Agero, Alfaro, Miguel Ignacio Cuchi, López, Juan Manuel Ramos, Haro, Mercedes García, Chávez, Abelardo Claudio Fernández, Valdés, Cornelia Bischofberger, Laso, Amaranta Mcgee, Liarte, Carmen Garrote, Montero, Gerardo Gómez, Cortes, Juan Daniel Miranda, Gomez, Gema Nieto, Herrero, Jessica Alia, de la Hoz San Clemente, Sara, Touya, Marta Gonzalez, Mambié, Moisés David Espejo, Gomez, Diana Carretero, Pareja, Manuela Serrano, Ruiz, Marco Antonio Espinel, Gallardo, Raquel Gutierrez, León, Eva Elisa Ãlvarez, Gutiérrez, Paloma Navas, Arzá, Nerea Armenteros, Montrull, Francisco Bolumar, de la Santa Viéuela, Ana García, Sanz, Raquel Arguedas, Redín, Miriam Roncal
Format:	Journal Article
Language:	English
Published:	London BioMed Central Ltd 17-08-2023 BioMed Central BMC
Subjects:	Admission and discharge Adverse events Analysis Appropriateness of health care Catheters Comorbidity Comparative analysis Cross-sectional studies Disease prevention Hospital patients Hospitalization Hospitals Inappropriate hospital admission Medical care Medical care, Cost of Medical research Medicine, Experimental Nosocomial infections Patient safety Patients Pediatrics Prevalence studies (Epidemiology) Risk factors Utilization Spain
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Summary:	Background All health overuse implies an unnecessary risk of patients suffering adverse events (AEs). However, this hypothesis has not been corroborated by direct estimates for inappropriate hospital admission (IHA). The objectives of the study were the following: (1) to analyze the association between IHA and the development of subsequent AEs; (2) to explore the distinct clinical and economic implications of AEs subsequent IHA compared to appropriate admissions. Methods An observational cross-sectional study was conducted on hospitalized patients in May 2019 in a high-complexity hospital in Madrid, Spain. The Appropriateness Evaluation Protocol was used to measure IHA, and the methodologies of the Harvard Medical Practice Study and the European Point Prevalence Survey of Healthcare-associated Infections were used to detect and characterize AEs. The association between IHA and the subsequent. Results A total of 558 patients in the hospital ward were studied. IHA increased the risk of subsequent occurrence of AEs (OR [95% CI]: 3.54 [1.87 to 6.69], versus appropriate) and doubled the mean AEs per patient (coefficient [95% CI]: 0.19 [0.08 to 0.30] increase, versus appropriate) after adjusting for confounders. IHA was a predictive variable of subsequent AEs and the number of AEs per patient. AEs developed after IHA were associated with scheduled admissions (78.9% of AEs, versus 27.9% after appropriate admissions; p < 0.001). Compared with AEs developed after appropriate admissions, AEs after IHA added 2.4 additional days of stay in the intensive care unit and incurred an extra cost of [euro]166,324.9 for the studied sample. Conclusions Patients with IHA have a higher risk of subsequent occurrence of AE. Due to the multifactorial nature of AEs, IHA is a possible contributing factor. AEs developed after IHA are associated with scheduled admissions, prolonged ICU stays, and resulted in significant cost overruns. Keywords: Appropriateness of health care, Inappropriate hospital admission, Patient safety, Adverse events
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	1741-7015 1741-7015
DOI:	10.1186/s12916-023-03024-0