QUEBEC CITY, Quebec — Preventable adverse events in hospitals occur three times more often among patients with communication problems, such as deafness, blindness, psychiatric disorders, and multiple health issues or comorbidities, found researchers in this study of nearly 2,400 patient records from 20 hospitals in Quebec. The report is published in the June 3 edition of the Canadian Medical Association Journal.

Specifically, the paper states that patients with “preventable adverse events were significantly more likely than those without such events to have a communication problem (odds ratio [OR] 3.00; 95% CI 1.43–6.27),” and “patients with communication problems were more likely than patients without these problems to experience multiple preventable adverse events (46% v. 20%; p = 0.05).”

An adverse event is “an unintended injury or complication caused by the delivery of clinical care rather than by the patient’s underlying condition.” Preventable adverse events occurred more often in women than in men and in patients over age 65. The most common adverse effects were drug related or caused by inappropriate treatment, treatment delay, or failure to monitor a patient’s condition.

The researchers found that 57% of patients who experienced a preventable adverse event had prolonged hospital stays (35%) were readmitted to hospital (32%) or discharged with minimal impairment or recovery (10%). A small percentage of patients experienced moderate impairment with recovery in 1 year (5%), experienced permanent impairment (3%), or died (6%).

“Almost half of the events were associated with some level of disability or multiple hospital admissions, with one-third of the patients who experienced preventable adverse events requiring readmission to hospital,” write Bartlett and coauthors. “These results emphasize the importance of providing additional resources for these patients to improve patient safety.”

The researchers urge, “[I]t is important for future research to investigate interpersonal dynamics that may be responsible. This research will become critical as the number of adults with disabilities affecting communication increases as the elderly population increases.”

In a commentary in the same edition of CMAJ, Allan Frankel, MD, of Institute for Healthcare Improvement, Cambridge, Mass, writes that all patients are at risk of preventable adverse events. Standardized care and simple mechanisms to improve patient understanding—such as clear, jargon-free language and having patients repeat instructions back to their care providers—need to be applied vigorously by health care professionals.

“This constellation of characteristics requires a health system whose very fabric has woven into it patience and cultural sensitivity, which is not exactly a picture of current general-care or emergency-response systems in most health care systems worldwide.”

SOURCE: EurekaAlert and CMAJ