Direct medical costs of adverse events in Dutch hospitals

Background: Various international studies have shown that a substantial number of patients suffer from injuries or even die as a result of care delivered in hospitals. The occurrence of injuries among patients caused by health care management in Dutch hospitals has never been studied systematically. Therefore, an epidemiological study was initiated to determine the incidence, type and impact of adverse events among discharged and deceased patients in Dutch hospitals. Methods/Design: Three stage retrospective patient record review study in 21 hospitals of 8400 patient records of discharged or deceased patients in 2004. The records were reviewed by trained nurses and physicians between August 2005 and October 2006. In addition to the determination of presence, the degree of preventability, and causes of adverse events, also location, timing, classification, and most responsible specialty of the adverse events were measured. Moreover, patient and admission characteristics and the quality of the patient records were recorded. Discussion: In this paper we report on the design of the retrospective patient record study on the occurrence of adverse events in Dutch hospitals. Attention is paid to the strengths and limitations of the study design. Furthermore, alterations made in the original research protocol in comparison with former international studies are described in detail.

Unfavorable long-term results of rectosigmoid neocolpopoiesis

We report on unfavorable long-term results after rectosigmoid neocolpopoiesis in 12 patients, as well as on possible prevention and treatment of these results. To prevent neovaginal introitus stenosis, the rectosigmoid mucosa should be sutured to the perineal skin in an ex-aggerated interdigital fashion. In cases where introitus stenosis has developed, pedicled transposition flaps from perineum or labia or from the gluteal or inguinal plica region have to be used. Similar flaps also may be applied in cases of rectovagina fistulas

A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones

Stress-related psychiatric disorders across the life spa

Adverse Drug Events in Older Hospitalized Patients: Results and Reliability of a Comprehensive and Structured Identification Strategy

<div><p>Background</p><p>Older patients are at high risk for experiencing Adverse Drug Events (ADEs) during hospitalization. To be able to reduce ADEs in these vulnerable patients, hospitals first need to measure the occurrence of ADEs, especially those that are preventable. However, data on preventable ADEs (pADEs) occurring during hospitalization in older patients are scarce, and no ‘gold standard’ for the identification of ADEs exists.</p><p>Methodology</p><p>The study was conducted in three hospitals in the Netherlands in 2007. ADEs were retrospectively identified by a team of experts using a comprehensive and structured patient chart review (PCR) combined with a trigger-tool as an aid. This ADE identification strategy was applied to a cohort of 250 older hospitalized patients. To estimate the intra- and inter-rater reliabilities, Cohen’s kappa values were calculated.</p><p>Principal Findings</p><p>In total, 118 ADEs were detected which occurred in 62 patients. This ADE yield was 1.1 to 2.7 times higher in comparison to other ADE studies in older hospitalized patients. Of the 118 ADEs, 83 (70.3%) were pADEs; 51 pADEs (43.2% of all ADEs identified) caused serious patient harm. Patient harm caused by ADEs resulted in various events. The overall intra-rater agreement of the developed strategy was substantial (κ = 0.74); the overall inter-rater agreement was only fair (κ = 0.24).</p><p>Conclusions/Significance</p><p>The ADE identification strategy provided a detailed insight into the scope of ADEs occurring in older hospitalized patients, and showed that the majority of (serious) ADEs can be prevented. Several strategy related aspects, as well as setting/study specific aspects, may have contributed to the results gained. These aspects should be considered whenever ADE measurements need to be conducted. The results regarding pADEs can be used to design tailored interventions to effectively reduce harm caused by medication errors. Improvement of the inter-rater reliability of a PCR remains challenging.</p></div

Characteristics of the included patients.

<p>SD - standard deviation, MDRD eGFR - Modification of Diet in Renal Disease estimated Glomerular Filtration Rate.</p>*<p>Days of hospitalization equals the length of stay on one of the internal medicine wards in days.</p>**<p>MDRD eGFR; for ten patients no laboratory tests were obtained during hospitalization to assess renal function.</p

Type of events related to Adverse Drug Events during hospitalization.

*<p>Events and subgroups of events were classified according to Common Terminology Criteria for Adverse Events (CTCEA) version 3.0 <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0071045#pone.0071045-Cancer1" target="_blank">[43]</a>.</p><p>ADEs - Adverse Drug Events; npADEs - nonpreventable Adverse Drug Events; pADEs - preventable Adverse Drug Events; AV – atrioventricular; INR - international normalization ratio; LTs – liverfunction tests.</p

Characteristics of nonpreventable and preventable Adverse Drug Events identified during hospitalization.

<p>ADEs - Adverse Drug Events; IHI - Institute for Healthcare Improvement.</p

Type of medication errors resulting in preventable Adverse Drug Events during hospitalization.

*<p>Medication was classified according to Anatomical Therapeutic Chemical (ATC) classification by World Health Organization Collaborating Centre for Drug Statistics Methodology <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0071045#pone.0071045-Anatomical1" target="_blank">[73]</a>.</p><p>pADEs - preventable Adverse Drug Events; RAAS - Renin-Angiotensin-Aldosterone-System; NSAIDs - Non-Steroidal Anti-Inflammatory Drugs.</p