Impact of patient communication problems on the risk of preventable adverse events in acute care settings

Abstract

Background: Up to 50% of adverse events that occur in hospitals are preventable. Language barriers and disabilities that affect communication have been shown to decrease quality of care. We sought to assess whether communication problems are associated with an increased risk of preventable adverse events.

Methods: We randomly selected 20 general hospitals in the province of Quebec with at least 1500 annual admissions. Of the 145,672 admissions to the selected hospitals in 2000/01, we randomly selected and reviewed 2355 charts of patients aged 18 years or older. Reviewers abstracted patient characteristics, including communication problems, and details of hospital admission, and assessed the cause and preventability of identified adverse events. The primary outcome was adverse events.

Results: Of 217 adverse events, 63 (29%) were judged to be preventable, for an overall population rate of 2.7% (95% confidence interval [CI] 2.1%-3.4%). We found that patients with preventable adverse events were significantly more likely than those without such events to have a communication problem (odds ratio [OR] 3.00; 95% CI 1.43-6.27) or a psychiatric disorder (OR 2.35; 95% CI 1.09-5.05). Patients who were admitted urgently were significantly more likely than patients whose admissions were elective to experience an event (OR 1.64, 95% CI 1.07-2.52). Preventable adverse events were mainly due to drug errors (40%) or poor clinical management (32%). We found that patients with communication problems were more likely than patients without these problems to experience multiple preventable adverse events (46% v. 20%; p = 0.05).

Interpretation: Patients with communication problems appeared to be at highest risk for preventable adverse events. Interventions to reduce the risk for these patients need to be developed and evaluated.

Figure 1: Relation between index admission and occurrence (O) and detection (D) of adverse events over time. *Information was available to determine the period of capture for 52 of 63 preventable adverse events and †93 of 154 nonpreventable adverse events.

Box 1

Figure 2: Selection of medical charts screened for the occurrence of a preventable adverse event.

Figure 3: Odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with preventable adverse events, adjusted for age, sex, Charlson Comorbidity Index score, admission status and type of hospital.