Higher incidence of adverse events in isolated patients compared with non-isolated patients: A cohort study

Objective To determine whether isolated patients admitted to hospital have a higher incidence of adverse events (AEs), to identify their nature, impact and preventability. Design Prospective cohort study with isolated and non-isolated patients. Setting One public university hospital in the Valencian Community (southeast Spain). Participants We consecutively collected 400 patients, 200 isolated and 200 non-isolated, age =18 years old, to match according to date of entry, admission department, sex, age (±5 years) and disease severity from April 2017 to October 2018. Exclusion criteria: patients age <18 years old and/or reverse isolation patients. Primary and secondary outcome measures The primary outcome as the AE, defined according to the National Study of Adverse Effects linked to Hospitalisation (Estudio Nacional Sobre los Efectos Adversos) criteria. Cumulative incidence rates and AE incidence density rates were calculated. Results The incidence of isolated patients with AEs 16.5% (95% CI 11.4% to 21.6%) compared with 9.5% (95% CI 5.4% to 13.6%) in non-isolated (p<0.03). The incidence density of patients with AEs among isolated patients was 11.8 per 1000?days/patient (95%?CI 7.8 to 15.9) compared with 4.3 per 1000?days/patient (95%?CI 2.4 to 6.3) among non-isolated patients (p<0.001). The incidence of AEs among isolated patients was 18.5% compared with 11% for non-isolated patients (p<0.09). Among the 37 AEs detected in 33 isolated patients, and the 22 AEs detected in 19 non-isolated patients, most corresponded to healthcare-associated infections (HAIs) for both isolated and non-isolated patients (48.6% vs 45.4%). There were significant differences with respect to the preventability of AEs, (67.6% among isolated patients compared with 52.6% among non-isolated patients). Conclusions AEs were significantly higher in isolated patients compared with non-isolated patients, more than half being preventable and with HAIs as the primary cause. It is essential to improve training and the safety culture of healthcare professionals relating to the care provided to this type of patient

Estudio de percepción de seguridad en pacientes aislados y no aislados en un hospital de agudos y análisis de concordancia con su identificación por los profesionales

Objetivo: Evaluar la percepción del paciente sobre la ocurrencia de incidentes relacionados con la seguridad (IRS) y eventos adversos (EA) en pacientes sometidos a precauciones de transmisión (pacientes aislados) y pacientes no aislados durante su ingreso hospitalario y compararlo con los identificados por los profesionales sanitarios en la revisión de las historias clínicas en un hospital público universitario de agudos de la provincia de Alicante. Metodología: Estudio transversal mediante encuesta telefónica a pacientes aislados y no aislados con cuestionario validado de percepción de seguridad sobre la ocurrencia de IRS y EA y posterior análisis de concordancia mediante coeficiente Kappa con los identificados por el personal sanitario en la revisión de historias clínicas. Resultados: Los pacientes aislados respecto a los no aislados, manifestaron haber tenido menos complicaciones médicas por alguna medicación y estas eran poco graves. Por el contrario, manifestaron tener algo más de complicaciones médicas por intervenciones quirúrgicas y ser poco graves. Finalmente, opinaron haber padecido más eventos adversos, respecto a los no aislados. Las diferencias no fueron estadísticamente significativas. En los resultados del índice de concordancia (índice Kappa), de identificación de EA de los pacientes durante su ingreso, y los identificados por los profesionales sanitarios en la revisión de las historias clínicas, se observó una fuerza de concordancia leve (Kappa= 0,061). Discusión: Los resultados de nuestro estudio pueden estar influenciados por una escasa información a los pacientes sobre su proceso clínico (diagnóstico, tratamientos y efectos adversos, etc…), esto podría ser la causa del bajo nivel de detección por los pacientes de los incidentes relacionados con la seguridad que hayan podido suceder durante su ingreso hospitalario. Los resultados de este estudio por lo tanto indican que los pacientes no son una fuente idónea para la detección de estos eventos, dado el bajo nivel de concordancia con el gold-estándar (revisión de historia clínica por profesionales sanitarios formados). Sin embargo, es muy posible que, si los pacientes recibieran formación sobre seguridad y tuvieran una mejor información sobre su proceso clínico durante el ingreso, podrían llegar a ser una fuente muy valiosa de información a la hora de detectar incidentes relacionados con la seguridad.Objective: To evaluate the perception of the patient about the occurrences of IRS and AE in patients subjected to transmission precautions (isolated patients) and non-isolated patients during their hospital admission and compare it with those identified by the health professionals in the review of the medical records in a public university hospital for acute care in the province of Alicante. Methodology: Cross-sectional study using a telephone survey in isolated and non-isolated patients with a validated questionnaire in the perception of safety on the occurrence of IRS and AEs and subsequent concordance analysis using the Kappa coefficient with the identifiers by the health personnel in the review of medical records. Results: The isolated patients compared to the non-isolated ones, stated that they had fewer medical complications due to any medication and these were not serious. On the contrary, they stated that they had slightly more medical complications from surgical interventions and that they were not very serious. Finally, they thought they had suffered more adverse events, compared to those not isolated. The differences were not statistically significant. In the results of the concordance index (Kappa index), for the identification of AEs of the patients during their admission, and those identified by the health professionals in the review of the medical records, a slight strength of concordance was discovered (Kappa= 0.061). Discussion: The results of our study may be influenced by insufficient information given to patients about their clinical process (diagnosis, treatments and adverse effects, etc…), this could be the cause of the low level of detection by patients of incidents related to the security that may have happened during their hospital admission. The results of this study therefore indicate that patients are not an ideal source for the detection of these events, given the low level of concordance with the gold-standard (medical record review by trained health professionals). However, it is quite possible that if patients received safety training and had better information about their clinical process during admission, they could become a very valuable source of information in detecting safety-related incident