Dataset Information

Rates of Adverse Events in Hospitalized Patients After Summer-Time Resident Changeover in the United States: Is There a July Effect?

ABSTRACT:

Objectives

This study aimed to determine whether patients in teaching hospitals are at higher risk of suffering from an adverse event during the summer trainee changeover period.

Methods

We performed a retrospective analysis of data from the Medicare Patient Safety Monitoring System, a medical-record abstraction-based database in the United States. Hospital admissions from 2010 to 2017 for acute myocardial infarction, heart failure, pneumonia, or a major surgical procedure were studied. Admissions were divided into nonsurgical (acute myocardial infarction, heart failure, or pneumonia) and surgical. Adverse event rates in July/August were compared with the rest of the year. Hospitals were stratified into major teaching, minor teaching, or nonteaching. Results were adjusted for patient demographics, comorbidities, and hospital characteristics. Outcomes were the adjusted odds of having at least 1 adverse event in July/August versus the rest of the year.

Results

We included 185,652 hospital admissions. The adjusted odds ratios (ORs) of suffering from at least one adverse event in a major teaching hospital in July/August was 0.83 (95% confidence interval [CI], 0.69-0.98) for nonsurgical patients and 1.09 (95% CI, 0.84-1.40) for surgical patients. In minor teaching hospitals, the adjusted ORs were 0.96 (95% CI, 0.88-1.04) for nonsurgical patients and 0.99 (95% CI, 0.87-1.12) for surgical patients. In nonteaching hospitals, the adjusted ORs were 0.98 (95% CI, 0.91-1.06) for nonsurgical patients and 1.10 (95% CI, 0.96-1.24) for surgical patients.

Conclusions

Patients admitted to teaching hospitals in July/August are not at increased risk of adverse events. These findings should reassure patients and medical educators that patients are not excessively endangered by admission to the hospital during these months.

SUBMITTER: Metersky ML

PROVIDER: S-EPMC8831642 | biostudies-literature | 2022 Apr

REPOSITORIES: biostudies-literature

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Publications

Rates of Adverse Events in Hospitalized Patients After Summer-Time Resident Changeover in the United States: Is There a July Effect?

Metersky Mark L ML Eldridge Noel N Wang Yun Y Eckenrode Sheila S Galusha Deron D Jaser Lisa L Mathew Jasie J Angus Steven S Nardino Robert R

Journal of patient safety 20220401 3

<h4>Objectives</h4>This study aimed to determine whether patients in teaching hospitals are at higher risk of suffering from an adverse event during the summer trainee changeover period.<h4>Methods</h4>We performed a retrospective analysis of data from the Medicare Patient Safety Monitoring System, a medical-record abstraction-based database in the United States. Hospital admissions from 2010 to 2017 for acute myocardial infarction, heart failure, pneumonia, or a major surgical procedure were st ...[more]

PMID: 34387249

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Project description:ObjectivesPneumonia hospitalization rates are frequently reported as a measure of pneumonia disease burden in the United States. However, a detailed understanding of pneumonia burden in all health care settings, including the emergency department (ED), is essential for measuring the full effect of this disease on the population and planning and evaluating interventions to reduce pneumonia-related morbidity. The aim of this study was to quantify pneumonia-attributable ED visits in the United States among children and adults during the 3-year period July 2006 through June 2009.MethodsRates of pneumonia ED visits were calculated using the Nationwide Emergency Department Sample (NEDS), the largest source of U.S. ED data. Pneumonia ED visits were identified using International Classification of Diseases (ICD) codes within NEDS. A pneumonia ED visit was defined by a primary (first-listed) pneumonia discharge diagnosis or a secondary pneumonia diagnosis with an accompanying primary diagnosis of respiratory failure, shock, septicemia, a sign or symptom consistent with pneumonia, another acute respiratory infection, or an acute exacerbation of a chronic pulmonary disease. Population-based annual rates of pneumonia ED visits stratified by age group and geographic region from July 2006 through June 2009 were calculated. The percentages of pneumonia ED visits resulting in treat-and-release outpatient ED visits were also calculated within each age stratum.ResultsDuring the study period, 6,917,025 ED visits for pneumonia were identified, representing 2.2% of all U.S. ED visits. During the 3 study years, defined as July through June of 2006-2007, 2007-2008, and 2008-2009, pneumonia ED visit rates per 1,000 person-years were 7.4 (95% confidence interval [CI] = 7.0 to 7.8), 7.8 (95% CI = 7.3 to 8.2), and 7.6 (95% CI = 7.1 to 8.0), respectively. Annual rates were stable over the 3 years within each age group and geographic region. Overall, 39.3% of pneumonia ED visits, including 74.5% of pediatric and 28.1% of adult visits, were managed as treat-and-release outpatient visits.ConclusionsPneumonia accounts for 2.2% of ED visits in the United States and results in approximately seven to eight ED visits per 1000 persons per year. A substantial proportion of pneumonia cases diagnosed in the ED are managed in treat-and-release ED outpatient visits, highlighting that enumeration of ED visit rates provides important complementary information to hospitalization rates for the assessment of pneumonia burden.

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Project description:BackgroundDetailed, nationally representative data describing high-risk populations and circumstances involved in antibiotic adverse events (AEs) can inform approaches to prevention.ObjectiveDescribe US burden, rates, and characteristics of emergency department (ED) visits by adults for antibiotic AEs.DesignNationally representative, public health surveillance of adverse drug events (National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance [NEISS-CADES]) and a nationally projected database of dispensed prescriptions (QuintilesIMS), 2011-2015.PatientsAntibiotic-treated adults (≥ 20 years) seeking ED care.Main measuresEstimated annual numbers and rates of ED visits for antibiotic AEs among outpatients treated with systemically administered antibiotics.Key resultsBased on 10,225 cases, US adults aged ≥ 20 years made an estimated 145,490 (95% confidence interval, 115,279-175,701) ED visits for antibiotic AEs each year in 2011-2015. Antibiotics were implicated in 13.7% (12.3-15.2%) of all estimated adult ED visits for adverse drug events. Most (56.6%; 54.8-58.4%) antibiotic AE visits involved adults aged < 50 years, and 71.8% (70.4-73.1%) involved females. Accounting for prescriptions dispensed from retail and long-term care pharmacies, adults aged 20-34 years had twice the estimated rate of ED visits for oral antibiotic AEs compared with those aged ≥ 65 years (9.7 [7.6-11.8] versus 4.6 [3.6-5.7] visits per 10,000 dispensed prescriptions, respectively). Allergic reactions accounted for three quarters (74.3%; 70.0-78.6%) of estimated ED visits for antibiotic AEs. The three most frequently implicated antibiotic classes in ED visits for antibiotic AEs were oral sulfonamides (23.2%; 20.6-25.8%), penicillins (20.8%; 19.3-22.4%), and quinolones (15.7%; 14.2-17.1%). Per-prescription rates declined with increasing age group.ConclusionsAntibiotics are a common cause of ED visits by adults for adverse drug events and represent an important safety issue. Quantifying risks of AEs from specific antibiotics for specific patient populations, such as younger adults, provides additional information to help clinicians assess risks versus benefits when making the decision to prescribe or not prescribe an antibiotic. AE rates may also facilitate communication with patients about antibiotic risks.

Dataset Information

Rates of Adverse Events in Hospitalized Patients After Summer-Time Resident Changeover in the United States: Is There a July Effect?

Objectives

Methods

Results

Conclusions

Publications

Rates of Adverse Events in Hospitalized Patients After Summer-Time Resident Changeover in the United States: Is There a July Effect?

Similar Datasets

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