Clinical Adverse Events in Elderly Hospitalized Patients in a Medical Ward - a Prospective Study

Introduction: Studies to date describe between 3% to 50% of patients experiencing one or more clinical adverse event (CAE) during their hospital admission and many preventable. The aim of this prospective study was to determine the frequency of medical CAEs in a medical ward. Also the study aimed to compare data between patient age groups and determine the effect on length of hospital stay and mortality. Methods: This is a prospective study, consulting patients’ electronic clinical notes over 6 months . Every week, all patient electronic processes were reviewed, and CAEs noted. The episode was only noted if the episode was clearly labeled as a CAEs by the medical team in the patient´s notes. If confounding factors were present, this episode was excluded. Patients were grouped by age; compared in terms of demographics, comorbidities, diagnosis at admission and readmission rate. Primary outcomes included mean length of stay and mortality. Results: 62 episodes were studied, 14.8% of those admitted to hospital experienced a CAE. The most frequent adverse events included analytical alterations, anemia and blood loss, infection and altered state of consciousness. The most commonly implicated therapies were anticoagulants (23%) which lead to episodes of bleeding, anti-hypertensive and diuretics (17%) immunosuppressive therapy (16%) beta blockers (1%) and insulin (1%). Mean length of stay in hospital was 17 days in all groups, longer than the average length of stay of this medical ward which is 11 days. Mortality rate within one year of hospitalization was 30% in total, again significantly higher than the 10% mortality rate calculated for the same period on the ward. Conclusion: This study demonstrates that CAEs are still far too common, probably underestimated, cause serious harm to patients and strains healthcare services further.