Skip to main content

Adverse drug events occurring following hospital discharge

Abstract

OBJECTIVE: To describe the incidence of adverse drug events (ADEs), preventable ADEs, and ameliorable ADEs occurring after hospital discharge and their associated risk factors.

DESIGN: Prospective cohort study.

SETTING: Urban academic health sciences center.

PATIENTS: Consecutive patients discharged home from the general medical service.

INTERVENTIONS: We determined posthospital outcomes approximately 24 days following discharge by performing a chart review and telephone interview. Using the telephone interview, we identified new or worsening symptoms, the patient’s health system use, and recollection of processes of care. Posthospital outcomes were judged by 2 internists independently.

RESULTS: Four hundred of 581 potentially eligible patients were evaluated. Of the 400 patients, 45 developed an ADE (incidence, 11%; 95% confidence interval [CI], 8% to 14%). Of these, 27% were preventable and 33% were ameliorable. Injuries were significant in 32 patients, serious in 6, and life threatening in 7. Patients were less likely to experience an ADE if they recalled having side effects of prescribed medications explained (OR, 0.4; 95% CI, 0.2 to 0.8). The risk of ADE per prescription was highest for corticosteroids, anticoagulants, antibiotics, analgesics, and cardiovascular medications. Risk increased with prescription number. Failure to monitor was an especially common cause of preventable and ameliorable ADEs.

CONCLUSION: Following discharge, ADEs were common and many were preventable or ameliorable. Medication side effects should be discussed, and interventions should include better monitoring and target patients receiving specific drug classes or multiple medications.

This is a preview of subscription content, access via your institution.

References

  1. Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991;324:370–6.

    PubMed  CAS  Article  Google Scholar 

  2. Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Newby L, Hamilton JD. The Quality in Australian Health Care Study. Med J Aust. 1995;163:458–71.

    PubMed  CAS  Google Scholar 

  3. Vincent C, Neale G, Woloshynowych M. Adverse events in British hospitals: preliminary retrospective record review. BMJ. 2001;322:517–9.

    PubMed  Article  CAS  Google Scholar 

  4. Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA. 1995;274:29–34.

    PubMed  Article  CAS  Google Scholar 

  5. Gurwitz JH, Field TS, Harrold LR, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003;289:1107–16.

    PubMed  Article  Google Scholar 

  6. Gandhi TK, Burstin HR, Cook EF, et al. Drug complications in outpatients. J Gen Intern Med. 2000;15:149–54.

    PubMed  Article  CAS  Google Scholar 

  7. Bates DW. Drugs and adverse drug reactions: how worried should we be? JAMA. 1998;279:1216–7.

    PubMed  Article  CAS  Google Scholar 

  8. Bates DW, Leape LL, Cullen DJ, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA. 1998;280:1311–6.

    PubMed  Article  CAS  Google Scholar 

  9. Bates DW, Leape LL, Petrycki S. Incidence and preventability of adverse drug events in hospitalized adults. J Gen Intern Med. 1993;8:289–94.

    PubMed  Article  CAS  Google Scholar 

  10. Bates DW, Boyle DL, Vander Vliet MB, Schneider J, Leape L. Relationship between medication errors and adverse drug events. J Gen Intern Med. 1995;10:199–205.

    PubMed  Article  CAS  Google Scholar 

  11. Bates DW, Spell N, Cullen DJ, et al. The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group. JAMA. 1997;277:307–11.

    PubMed  Article  CAS  Google Scholar 

  12. Bates DW. Using information technology to reduce rates of medication errors in hospitals. BMJ. 2000;320:788–91.

    PubMed  Article  CAS  Google Scholar 

  13. Cullen DJ, Sweitzer BJ, Bates DW, Burdick E, Edmondson A, Leape LL. Preventable adverse drug events in hospitalized patients: a comparative study of intensive care and general care units. Crit Care Med. 1997;25:1289–97.

    PubMed  Article  CAS  Google Scholar 

  14. Leape LL, Bates DW, Cullen DJ, et al. Systems analysis of adverse drug events. ADE Prevention Study Group. JAMA. 1995;274:35–43.

    PubMed  Article  CAS  Google Scholar 

  15. Leape LL, Cullen DJ, Clapp MD, et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA. 1999;282:267–70.

    PubMed  Article  CAS  Google Scholar 

  16. Brook RH, Appel FA, Avery C, Orman M, Stevenson RL. Effectiveness of inpatient follow-up care. N Engl J Med. 1971;285:1509–14.

    PubMed  CAS  Article  Google Scholar 

  17. Himmel W, Tabache M, Kochen MM. What happens to long-term medication when general practice patients are referred to hospital? Eur J Clin Pharmacol. 1996;50:253–7.

    PubMed  Article  CAS  Google Scholar 

  18. Parkin DM, Henney CR, Quirk J, Crooks J. Deviation from prescribed drug treatment after discharge from hospital. BMJ. 1976;2:686–8.

    PubMed  CAS  Article  Google Scholar 

  19. Katz E, Nicod P, Brunner HR, Waeber B. Changes in treatment during and after hospitalization in patients taking drugs for cardiovascular diseases. Cardiovasc Drugs Ther. 1996;10:189–92.

    PubMed  Article  CAS  Google Scholar 

  20. van Walraven C, Weinberg AL. Quality assessment of a discharge summary system. CMAJ. 1995;152:1437–42.

    PubMed  Google Scholar 

  21. Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients following discharge from the hospital. Ann Intern Med. 2003;138:161–7.

    PubMed  Google Scholar 

  22. Kaushal R, Bates DW, Landrigan C, et al. Medication errors and adverse drug events in pediatric inpatients. JAMA. 2001;285:2114–20.

    PubMed  Article  CAS  Google Scholar 

  23. Gandhi TK, Weingart SN, Borus J, et al. Adverse drug events in ambulatory care. N Engl J Med. 2003;348:1556–64.

    PubMed  Article  Google Scholar 

  24. Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. Adverse drug events occurring following hospital discharge. J Gen Intern Med. 2003;18(suppl 1):282. Abstract.

    Google Scholar 

  25. Gurwitz JH, Field TS, Avorn J, et al. Incidence and preventability of adverse drug events in nursing homes. Am J Med. 2000;109:87–94.

    PubMed  Article  CAS  Google Scholar 

  26. The Institute of Medicine. To Err Is Human: Building a Safer Health System. Washington DC: National Academy Press; 2000.

    Google Scholar 

  27. Forster AJ, Clark HD, Menard A, et al. Adverse events affecting medical patients following discharge from hospital. CMAJ. 2004;170:345–9.

    PubMed  Google Scholar 

  28. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–9.

    PubMed  Article  CAS  Google Scholar 

  29. Barsky AJ, Saintfort R, Rogers MP, Borus JF. Nonspecific medication side effects and the nocebo phenomenon. JAMA. 2002;287:622–7.

    PubMed  Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alan J. Forster MD, FRCPC, MSc.

Additional information

There are no conflicts of interest to report.

Dr. Forster was supported in this research by an R. Samuel McLaughlin Fellowship.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Forster, A.J., Murff, H.J., Peterson, J.F. et al. Adverse drug events occurring following hospital discharge. J GEN INTERN MED 20, 317–323 (2005). https://doi.org/10.1111/j.1525-1497.2005.30390.x

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1111/j.1525-1497.2005.30390.x

Key words

  • patient safety
  • adverse drug reactions
  • medical errors
  • hospital care