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Observational Study
. 2026 Jan;26(1):100546.
doi: 10.1016/j.clinme.2025.100546. Epub 2025 Dec 15.

Impact of patient safety on hospital prognosis: Association between adverse events and in-hospital mortalit

Miriam Roncal-Redin  1 , Diego San Jose-Saras  2 , Cristina Díaz-Agero Pérez  3 , Jorge Vicente-Guijarro  4 , Paloma Moreno-Nunez  5 , Alberto Pardo-Hernandez  6 , Jesus María Aranaz-Andrés  7 ; ESHMAD director group and external advisers
Collaborators, Affiliations
Observational Study

Impact of patient safety on hospital prognosis: Association between adverse events and in-hospital mortalit

Miriam Roncal-Redin et al. Clin Med (Lond). 2026 Jan.

Abstract

Introduction: Adverse events (AEs) involve a safety problem and compromise the quality of care, but evidence on how they affect the prognosis of patients is limited.

Objective: In this study, the relationship between the presence of AEs and in-hospital mortality among patients is analysed, and their characteristics are compared.

Material and methods: An observational study with a cross-sectional design was conducted in 32 hospitals of varying complexity in the Community of Madrid. The clinical history of 9,111 patients was analysed. Patients who were in the emergency room and those admitted to psychiatric units or centres were excluded. All hospitalisations were reviewed using the Harvard Medical Practice Study methodology for the detection and characterisation of AEs. The association between in-hospital mortality and the number of AEs was analysed with two multivariate models via logistic regression: 1) an explanatory model adjusted for confounders and 2) a predictive model of in-hospital mortality. A descriptive analysis of the differential characteristics of the AE was performed for the patients who died.

Results: In-hospital mortality was 5%, with a higher incidence of AEs in patients who died (29.8% versus 11.9%; p < 0.005). The presence of 1 AE (OR [95% CI]: 2.1 [1.6 to 2.7]) or ≥3 AEs (2.4 [1.1 to 5.1]) significantly increased the odds of mortality. In addition, the increase in the number of AEs was a predictor of mortality without a dose-response effect. The AEs that were most associated with in-hospital mortality were those related to care (15.5%; p = 0.047), and 15.3% of the AEs that occurred during ward care contributed to in-hospital mortality.

Conclusion: There is an association between AEs and in-hospital mortality. The presence of at least 1 AE implies a critical event in the patient's prognosis without a dose-response effect. Reducing AEs related to care in patients with comorbidities is positioned as an efficient strategy for improving health outcomes.

Keywords: Adverse events; Health care; In-hospital mortality; Patient safety.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1
Fig. 1
Flow diagram.
Fig 2
Fig. 2
Crude versus adjusted ORs for in-hospital mortality and the presence of 1 AE, 2 AEs or ≥3 AEs.
See this image and copyright information in PMC

References

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