Incidence and types of preventable adverse events in elderly patients: population based review of medical records

doi:10.1136/bmj.320.7237.741

BMJ 2000;320:741-744 ( 18 March )

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Incidence and types of preventable adverse events in elderly patients: population based review of medical records

Eric J Thomas, assistant professor, ^a Troyen A Brennan, professor of medicine. ^b

^a University of Texas-Houston Medical School, Department of Medicine, Division of General Internal Medicine, and Section for Clinical Epidemiology, 6431 Fannin MSB 1.122, Houston, TX 77030, USA, ^b Brigham and Women's Hospital and Harvard Medical School, Division of General Medicine, Department of Medicine, 75 Francis Street, Boston, MA 02115, USA

Correspondence to: E J Thomas ethomas{at}heart.med.uth.tmc.edu

Objective: To determine the incidence and types of preventableadverse events in elderlypatients.
Design: Review of random sample of medical recordsin two stage process by nurses and physicians to detect adverseevents. Two study investigators then judgedpreventability.
Setting: Hospitals in US states of Utah and Colorado,excluding psychiatric and Veterans Administrationhospitals.
Subjects: 15 000 hospitalised patients discharged in1992.
Main outcome measures: Incidence of preventable adverse events (numberof preventable events per 100 discharges) in elderly patients( $>=$ 65 years old) and non-elderly patients (16-64years).
Results: When results were extrapolated to representall discharges in 1992 in both states, non-elderly patients had8901 adverse events (incidence 2.80% (SE 0.18%)) compared with7419 (5.29% (0.37%)) among elderly patients (P=0.001). Non-elderlypatients had 5038 preventable adverse events (incidence 1.58%(0.14%)) compared with 4134 (2.95% (0.28%)) in elderly patients(P=0.001). Elderly patients had a higher incidence of preventableevents related to medical procedures (such as thoracentesis, cardiaccatheterisation) (0.69% (0.14%) v 0.13% (0.04%)), preventableadverse drug events (0.63% (0.14%) v 0.17% (0.05%)), and preventablefalls (0.10% (0.06%) v 0.01% (0.02%)). In multivariate analyses,adjusted for comorbid illnesses and case mix, age was not an independentpredictor of preventable adverseevents.
Conclusions: Preventable adverse events were more commonamong elderly patients, probably because of the clinical complexityof their care rather than age based discrimination. Preventableadverse drug events, events related to medical procedures, andfalls were especially common in elderly patients and should betargets for efforts to preventerrors.

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