The Joint Commission Journal on Quality and Patient Safety has accepted a paper authored by Dr. Dennis Tsilimingras, a 1995 graduate of the WSU School of Medicine who recently joined the Division of Translational Research and Clinical Epidemiology of the WSU Department of Internal Medicine. The manuscript, "Post-Discharge Adverse Events: A Neglected Area," examines post-discharge safety, an area that has long been neglected in the health-care system.
Recent studies from the United States and Canada addressing adverse events occurring after discharge from the hospital found a 19 percent and 23 percent incidence rate, respectively, among patients discharged from the general internal medicine services of major teaching hospitals. These rates are much higher than in-hospital adverse event rates ranging between 2.9 percent to 3.7 percent, as estimated by the Institute of Medicine landmark report "To Err Is Human," based on data from two large population-based studies in the United States.
An explanation for the higher adverse event rates during the post-discharge period may be the progressive shortening of hospitalizations for patients since the time of the two large population-based studies. As a result, many things used to occur in the hospital now occur afterwards, raising the concern that even more adverse events may be occurring after discharge as reported in the recent post-discharge studies.
This suggests that the estimated overall annual incidence rate of adverse events may actually be much higher than that cited by the Institute of Medicine report, since neither post-discharge nor ambulatory adverse events were pursued in the studies it cited. Since the incidence rate involving medical patients for post-discharge adverse events may be as much as five to six times higher when compared to in-hospital adverse events, it is essential for physicians to learn more about post-discharge adverse events and improve the safety of care for patients who have been recently discharged.
This manuscript examines: 1) patient safety definitions in this setting; 2) discontinuities in care as the scientific rationale for the occurrence of post-discharge adverse events; 3) post-discharge adverse event studies; 4) the common types of post-discharge adverse events; and it also makes specific recommendations for the improvement of post-discharge care.
The article will be featured in the journal's January issue.
Dr. Tsilimingras began his research career in the Department of Epidemiology at the University of Michigan School of Public Health. Then, he completed a master's of public health in health services and epidemiologic research at the Boston University School of Public Health. He was recruited by the Bedford Veterans Affairs Hospital, a Center of Excellence for Health Services Research, and the Department of Health Policy and Management at The Boston University School of Public Health. There, he was an investigator for several health services research studies focusing on the improvement of quality of care, health outcomes and patient safety in Veteran Affairs hospitals.
Tsilimingras was among a national group of clinicians and research scientists invited by the Stanford University - University of California San Francisco Evidence Based Practice Center to participate in the development of the Agency for Healthcare Research and Quality "Hospital Patient Safety Indicators." He authored the initial manuscript that specifically examined patient safety implications for elderly patients and the geriatric practice. His research interests include hypertension/cardiovascular disease, improvement of quality of care and patient safety.