Errors Common After Hospital Discharge

Poor Communication and Monitoring Increase Vulnerability to Medical Mistakes

From the WebMD Archives

Feb. 3, 2003 -- Medical mistakes are to blame for tens of thousands of deaths among hospitalized patients in the United States each year. New research suggests that similar mistakes are also common once patients have left the hospital.


A follow-up of 400 consecutive patients released from an urban teaching hospital shows that one out of five experienced adverse events when they went home, caused by inadequate medical management. Researchers concluded that a third of the post-discharge events could have been avoided and another third could have been less severe if patients had received proper care. Their findings are reported in the February issue of the journal Annals of Internal Medicine.


"A lot of patients are having problems after they leave the hospital, and many of these problems aren't being addressed," lead researcher Alan J. Forster, MD, FRCPC, tells WebMD. "Clearly the transition from hospital to home is a vulnerable period, and we have to do a better job of making sure patients get the help they need."


Problems with prescribed drugs were the most common cause of injury, accounting for 66% of all adverse events after discharge. More than a third of the drug events (38%) involved antibiotics, while 16% involved corticosteroids, 16% involved cardiovascular drugs, and 10% involved pain relievers.


The severity of the events ranged from laboratory problems that went unnoticed to those causing permanent disability. Forty-nine patients (64%) had several days of symptoms; such as a rash caused by antibiotics, insomnia due to corticosteroid use, or constipation caused by pain medications. Two patients (3%) had permanent disabilities.


Forster says medical errors could be reduced by more thoroughly evaluating patients before discharge, monitoring them better after their release from the hospital, and educating them about the side effects and interactions of the drugs they are taking.


A major problem, he tells WebMD, is that there is often no communication between the medical team taking care of a patient in the hospital and the doctors who see them once they are released. This transitional period is vulnerable to adverse events, they authors write.


Janet Corrigan, PhD, says the key to better communication is making patient information available to doctors electronically.


Corrigan led a government panel that made headlines three years ago by finding that medical errors cause more deaths in the United States each year than highway accidents, breast cancer, or AIDS. The Institute of Medicine (IOM) report called on federal officials to enact laws requiring better reporting of medical errors, and it made recommendations to reduce them.


Some of those recommendations have been followed, Corrigan tells WebMD, while others have not. She says it is unclear whether medical errors are occurring more or less frequently these days, because there is still no system in place to monitor them. Corrigan is director of the IOM board of health services.


"We have not seen the widespread investment in the information technology that is going to be critical to reducing medical errors both inside and outside of hospitals," she says. "Improving communication is absolutely essential."



Show Sources

SOURCES:Annals of Internal Medicine, February 2003 * Alan J. Forster, MD, FRCPC, associate scientist, Ottawa Health Research Institute; and assistant professor, University of Ottawa * Janet Corrigan, PhD, director, Institute of Medicine board of health care sciences.
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