Adverse Events and Rural Discharges

The Center on Patient Safety at Florida State University College of Medicine in Tallahassee has been awarded a two-year, $908,000 grant from the federal Agency for Healthcare Research and Quality to study adverse events during the three weeks following hospital discharge, both for urban patients and, for the first time, those returning to rural settings.

Center director Dennis Tsilimingras, MD, MPH, says the project will enroll 600 patients, half urban and half rural, discharged by the Tallahassee Memorial Hospitalist Group, and track injuries resulting from medical errors, including medication errors, procedure-related injuries, nosocomial infections, and pressure ulcers.

Errors or injuries to patients may occur in the hospital but not be identified until after the patient goes home, he says, and such errors could contribute to rehospitalizations. “Our hypothesis is that the rate of adverse events post-discharge may be greater among rural patients because they have less access to follow-up care,” he adds.

Dr. Tsilimingras will be working closely with hospitalists, and Phase 2 of the research will use the hospital’s post-discharge transitional care clinic (see “Is a Post-Discharge Clinic in Your Hospital’s Future?,” December 2011) as an intervention strategy.

The eventual goal is to develop a screening tool to flag risk for post-discharge adverse events and develop strategies to reduce post-discharge problems, including readmissions, a quarter of which may be related to post-discharge adverse events, Dr. Tsilimingras says. He encourages hospitalists to reevaluate their patients and review their charts at the time of discharge, to see if post-discharge problems loom, and to reach out to primary care physicians by telephone, rather than just sending discharge summaries.

Larry Beresford is a freelance writer in Oakland, Calif.

References

1. Armellino D, Hussain E, Schilling ME, et al. Using high-technology to enforce low-technology safety measures: the use of third-party remote video auditing and real-time feedback in healthcare [published online ahead of print Nov. 21, 2011. Clin Infect Dis. doi;10.1093/cid/cir773.
2. Fuller C, Savage J, Besser S, et al. “The dirty handin the latex glove”: a study of hand hygiene compliance when gloves are worn. Infect Control Hosp Epidemiol. 2011;32(12):1194-1199.