Evaluation of clinically significant adverse events in patients discharged from a tertiary-care emergency department in Taiwan
- 1Department of Emergency Medicine, Taichung Veterans General Hospital, Taiwan, ROC
- 2Emergency Medicine, School of Medicine, National Yang-Ming University, Taiwan, ROC
- 3Institute of Health Care Organization Administration, National Taiwan University, Taiwan, ROC
- 4Department of Emergency Medicine, Taipei Veterans General Hospital, Taiwan, ROC
- Correspondence to Dr Chii-Hwa Chern, Department of Emergency Medicine, Taipei Veterans General Hospital, Taiwan 112, ROC;
Contributors L-MW and C-HC contributed to the study concept and design and take responsibility for the whole paper. C-HC and SS provided supervision and administrative support. C-HC provided funding. L-MW and C-KH were responsible for acquisition of data. M-CY designed, analysed and interpreted the data and provided statistical expertise. L-MW and C-HC drafted the manuscript. SS contributed to critical revision of the manuscript.
- Accepted 21 February 2012
- Published Online First 20 March 2012
Objective To investigate the reasons for the occurrence of clinically significant adverse events (CSAEs) in emergency department-discharged patients through emergency physicians' (EPs) subjective reasoning and senior EPs' objective evaluation.
Design This was a combined prospective follow-up and retrospective review of cases of consecutive adult non-traumatic patients who presented to a tertiary-care emergency department in Taiwan between 1 September 2005 and 31 July 2006. Data were extracted from ‘on-duty EPs' subjective reasoning for discharging patients with CSAEs (study group) and without CSAEs (control group)’ and ‘objective evaluation of CSAEs by senior EPs, using clinical evidences such as recording history, physical examinations, laboratory/radiological examinations and observation of inadequacies in the basic management process (such as recording history, physical examinations, laboratory/radiological examinations and observation) as the guide’. Subjective reasons for discharging patients’ improvement of symptoms, and the certainty of safety of the discharge were compared in the two groups using χ2 statistics or t test.
Results Of the 20 512 discharged cases, there were 1370 return visits (6.7%, 95% CI 6.3% to 7%) and 165 CSAEs due to physicians' factors (0.82%, 95% CI 0.75% to 0.95%). In comparisons between the study group and the control group, only some components of discharge reasoning showed a significant difference (p<0.001). Inadequacies in the basic management process were the main cause of CSAEs (164/165).
Conclusion The authors recommended that EP follow-up of the basic management processes (including history record, physical examination, laboratory and radiological examinations, clinical symptoms/signs and treatment) using clinical evidence as a guideline should be made mandatory.
- CSAEs (clinically significant adverse events)
- ED (emergency department)
- EPs (emergency physicians)
- BMP (basic management process)
- emergency care systems
- environmental medicine
Funding This study was supported by a grant from the National Science Council, Taiwan, ROC (NSC: 94-2314-B-075-112).
Competing interests None.
Ethics approval This study was approved by the institutional review board of Taipei Veterans General Hospital, Taiwan.
Provenance and peer review Not commissioned; internally peer reviewed.
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/3.0/ and http://creativecommons.org/licenses/by-nc/3.0/legalcode