Impact of medication characteristics and adverse drug events on hospital admission after an emergency department visit: Prospective cohort study
Laura Lohan
Clinical Pharmacy Department, CHU Montpellier, Univ Montpellier, Montpellier, France
PhyMedExp, Univ Montpellier, CNRS, INSERM, Montpellier, France
Search for more papers by this authorGregory Marin
Clinical Research and Epidemiology Unit, CHU Montpellier, Univ Montpellier, Montpellier, France
Search for more papers by this authorMarie Faucanie
Clinical Research and Epidemiology Unit, CHU Montpellier, Univ Montpellier, Montpellier, France
Search for more papers by this authorMarion Laureau
Clinical Pharmacy Department, CHU Montpellier, Univ Montpellier, Montpellier, France
Emergency Medicine Department, CHU Montpellier, Univ Montpellier, Montpellier, France
Search for more papers by this authorValérie Macioce
Clinical Research and Epidemiology Unit, CHU Montpellier, Univ Montpellier, Montpellier, France
Search for more papers by this authorDamien Perier
Emergency Medicine Department, CHU Montpellier, Univ Montpellier, Montpellier, France
Search for more papers by this authorVeronique Pinzani
Medical Pharmacology and Toxicology Department, CHU Montpellier, Univ Montpellier, Montpellier, France
Search for more papers by this authorIsabelle Giraud
Economic Evaluation Unit, Univ Montpellier, CHU Montpellier, Montpellier, France
Search for more papers by this authorAudrey Castet-Nicolas
Clinical Pharmacy Department, CHU Montpellier, Univ Montpellier, Montpellier, France
Search for more papers by this authorAnne Jalabert
Clinical Pharmacy Department, CHU Montpellier, Univ Montpellier, Montpellier, France
Search for more papers by this authorMaxime Villiet
Clinical Pharmacy Department, CHU Montpellier, Univ Montpellier, Montpellier, France
Search for more papers by this authorMustapha Sebbane
Emergency Medicine Department, CHU Montpellier, Univ Montpellier, Montpellier, France
Search for more papers by this authorCorresponding Author
Cyril Breuker
Clinical Pharmacy Department, CHU Montpellier, Univ Montpellier, Montpellier, France
PhyMedExp, Univ Montpellier, CNRS, INSERM, Montpellier, France
Correspondence
Cyril Breuker, Clinical Pharmacy Department, University Hospital, Montpellier, 371 avenue du doyen Gaston Giraud 34295 Montpellier, France.
Email: [email protected]
Search for more papers by this authorLaura Lohan
Clinical Pharmacy Department, CHU Montpellier, Univ Montpellier, Montpellier, France
PhyMedExp, Univ Montpellier, CNRS, INSERM, Montpellier, France
Search for more papers by this authorGregory Marin
Clinical Research and Epidemiology Unit, CHU Montpellier, Univ Montpellier, Montpellier, France
Search for more papers by this authorMarie Faucanie
Clinical Research and Epidemiology Unit, CHU Montpellier, Univ Montpellier, Montpellier, France
Search for more papers by this authorMarion Laureau
Clinical Pharmacy Department, CHU Montpellier, Univ Montpellier, Montpellier, France
Emergency Medicine Department, CHU Montpellier, Univ Montpellier, Montpellier, France
Search for more papers by this authorValérie Macioce
Clinical Research and Epidemiology Unit, CHU Montpellier, Univ Montpellier, Montpellier, France
Search for more papers by this authorDamien Perier
Emergency Medicine Department, CHU Montpellier, Univ Montpellier, Montpellier, France
Search for more papers by this authorVeronique Pinzani
Medical Pharmacology and Toxicology Department, CHU Montpellier, Univ Montpellier, Montpellier, France
Search for more papers by this authorIsabelle Giraud
Economic Evaluation Unit, Univ Montpellier, CHU Montpellier, Montpellier, France
Search for more papers by this authorAudrey Castet-Nicolas
Clinical Pharmacy Department, CHU Montpellier, Univ Montpellier, Montpellier, France
Search for more papers by this authorAnne Jalabert
Clinical Pharmacy Department, CHU Montpellier, Univ Montpellier, Montpellier, France
Search for more papers by this authorMaxime Villiet
Clinical Pharmacy Department, CHU Montpellier, Univ Montpellier, Montpellier, France
Search for more papers by this authorMustapha Sebbane
Emergency Medicine Department, CHU Montpellier, Univ Montpellier, Montpellier, France
Search for more papers by this authorCorresponding Author
Cyril Breuker
Clinical Pharmacy Department, CHU Montpellier, Univ Montpellier, Montpellier, France
PhyMedExp, Univ Montpellier, CNRS, INSERM, Montpellier, France
Correspondence
Cyril Breuker, Clinical Pharmacy Department, University Hospital, Montpellier, 371 avenue du doyen Gaston Giraud 34295 Montpellier, France.
Email: [email protected]
Search for more papers by this authorAbstract
Objectives
Emergency department (ED) overcrowding is a problem for the delivery of adequate and timely emergency care. To improve patient flow and the admission process, the quick prediction of a patient's need for admission is crucial. We aimed to investigate the variables associated with hospitalisation after an ED visit, with a particular focus on the variables related to medication.
Methods
This prospective study was conducted from 2011 to 2018 in subacute medical ED of a French University Hospital. Specialised EDs (paediatric, gynaecologic, head and neck and psychiatric) and the outpatient unit of the ED were not included. Participation in this study was proposed to all adult patients who underwent a medication history interview with a pharmacist. Pharmacists conducted structured interviews for the completion of the medication history and the detection of adverse drug events (ADE). Relations between patient characteristics and hospitalisation were analysed using logistic regression.
Results
Among the 14 511 included patients, 5972 (41.2%) were hospitalised including 69 deaths. In total, 7458 patients (51.4%) took more than 5 medications and 2846 patients (19.6%) had an ADE detected during the ED visit. In hospitalised patients, bleeding (32.2%) and metabolic disorders (16.8%) were the most observed ADE symptoms. Variables associated with increased hospital admission included 2 demographic variables (age, male gender), 4 clinical variables (renal and hepatic failures, alcohol addiction, ED visit for respiratory reason) and 6 medication-related variables (medications >5, use of blood, systemic anti-infective, metabolism and antineoplastic/immunomodulating medications and ADE).
Conclusion
We identified variables associated with hospitalisation including drug-related variables. These results point out the importance and the relevance of collecting medication data in a subacute medical ED (study registered on ClinicalTrials.gov, NCT03442010).
Supporting Information
| Filename | Description |
|---|---|
| ijcp14224-sup-0001-FigS1.pdfPDF document, 387.9 KB | Fig S1 |
| ijcp14224-sup-0002-TableS1.docxWord document, 13.3 KB | Table S1 |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
REFERENCES
- 1Steventon A, Deeny S, Friebal R, Gadner T, Thorlby R. Emergency hospital admissions in England: which may be avoidable and how?. The Health Fondation; 2018. https://www.health.org.uk/publications/emergency-hospital-admissions-in-england-which-may-be-avoidable-and-how. Accessed April 27, 2020.
- 2 National Audit Office. Reducing Emergency Admissions; 2018. https://www.nao.org.uk/report/reducing-emergency-admissions. Accessed April 27, 2020.
- 3Krumholz HM. Post-hospital syndrome–an acquired, transient condition of generalized risk. N Engl J Med. 2013; 368: 100-102.
- 4Purdy S. Avoiding hospital admission; what does the research evidence say?. The King’s Fund; 2010. https://www.kingsfund.org.uk/sites/default/files/Avoiding-Hospital-Admissions-Sarah-Purdy-December2010.pdf. Accessed July 15, 2020.
- 5Wallace E, Stuart E, Vaughan N, Bennett K, Fahey T, Smith SM. Risk prediction models to predict emergency hospital admission in community-dwelling adults: a systematic review. Med Care. 2014; 52: 751-765.
- 6Kingston MR, Evans BA, Nelson K, Hutchings H, Russell I, Snooks H. Costs, effects and implementation of routine data emergency admission risk prediction models in primary care for patients with, or at risk of, chronic conditions: a systematic review protocol. BMJ Open. 2016; 6:e009653.
- 7Cameron A, Rodgers K, Ireland A, Jamdar R, McKay GA. A simple tool to predict admission at the time of triage. Emerg Med J. 2015; 32: 174-179.
- 8Dinh MM, Russell SB, Bein KJ, et al. The Sydney Triage to Admission Risk Tool (START) to predict Emergency Department Disposition: a derivation and internal validation study using retrospective state-wide data from New South Wales, Australia. BMC Emerg Med. 2016; 16: 46.
- 9Kim SW, Li JY, Hakendorf P, Teubner DJ, Ben-Tovim DI, Thompson CH. Predicting admission of patients by their presentation to the emergency department. Emergency Med Aust. 2014; 26: 361-367.
- 10Parker CA, Liu N, Wu SX, Shen Y, Lam SSW, Ong MEH. Predicting hospital admission at the emergency department triage: a novel prediction model. Am J Emerg Med. 2019; 37: 1498-1504.
- 11Peck JS, Benneyan JC, Nightingale DJ, Gaehde SA. Predicting emergency department inpatient admissions to improve same-day patient flow. Acad Emergency Med. 2012; 19: E1045-E1054.
- 12Sun BC, Hsia RY, Weiss RE, et al. Effect of emergency department crowding on outcomes of admitted patients. Ann Emergency Med. 2013; 61: 605-611.e6.
- 13Sun BC, Adams J, Orav EJ, Rucker DW, Brennan TA, Burstin HR. Determinants of patient satisfaction and willingness to return with emergency care. Ann Emergency Med. 2000; 35: 426-434.
- 14Derlet RW, Richards JR. Overcrowding in the nation's emergency departments: complex causes and disturbing effects. Ann Emergency Med. 2000; 35: 63-68.
- 15Ayalew MB, Tegegn HG, Abdela OA. Drug Related Hospital Admissions; A systematic review of the recent literatures. Bull Emergency Trauma. 2019; 7: 339-346.
- 16Laureau M, Vuillot O, Gourhant V, et al. Adverse drug events detected by clinical pharmacists in an emergency department: a prospective monocentric observational study. J Patient Saf. 2020. https://doi.org/10.1097/PTS.0000000000000679
- 17van den Bemt PM, van der Schrieck-de Loos EM, van der Linden C, Theeuwes AM, Pol AG; Dutch CBOWHOHsSG. Effect of medication reconciliation on unintentional medication discrepancies in acute hospital admissions of elderly adults: a multicenter study. J Am Geriatr Soc. 2013; 61: 1262-1268.
- 18Breuker C, Macioce V, Mura T, et al. Medication errors at hospital admission and discharge: risk factors and impact of medication reconciliation process to improve healthcare. J Patient Saf. 2017. https://doi.org/10.1097/PTS.0000000000000420
- 19 Institute of Medicine Committee on Quality of Health Care. Errors in health care: a leading cause of death and injury. In: LT Kohn, JM Corrigan, MS Donaldson, eds. To Err is Human: Building a Safer Health System. Washington (DC): National Academies Press (US); 2000.
- 20Arimone Y, Bidault I, Dutertre JP, et al. Updating the French method for the causality assessment of adverse drug reactions. Therapie. 2013; 68: 69-76.
- 21Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981; 30: 239-245.
- 22Taboulet P, Moreira V, Haas L, et al. Triage with the French Emergency Nurses Classification in Hospital scale: reliability and validity. Eur J Emerg Med. 2009; 16: 61-67.
- 23Sun Y, Heng BH, Tay SY, Seow E. Predicting hospital admissions at emergency department triage using routine administrative data. Acad Emergency Med. 2011; 18: 844-850.
- 24Hong WS, Haimovich AD, Taylor RA. Predicting hospital admission at emergency department triage using machine learning. PLoS One. 2018; 13:e0201016.
- 25Lyon D, Lancaster GA, Taylor S, Dowrick C, Chellaswamy H. Predicting the likelihood of emergency admission to hospital of older people: development and validation of the Emergency Admission Risk Likelihood Index (EARLI). Fam Pract. 2007; 24: 158-167.
- 26Caglar S, Henneman PL, Blank FS, Smithline HA, Henneman EA. Emergency department medication lists are not accurate. J Emergency Med. 2011; 40: 613-616.
- 27Mazer M, Deroos F, Hollander JE, McCusker C, Peacock N, Perrone J. Medication history taking in emergency department triage is inaccurate and incomplete. Acad Emergency Med. 2011; 18: 102-104.
- 28Stergiopoulos S, Brown CA, Felix T, Grampp G, Getz KA. A survey of adverse event reporting practices among US healthcare professionals. Drug Saf. 2016; 39: 1117-1127.
- 29Hazell L, Shakir SA. Under-reporting of adverse drug reactions: a systematic review. Drug Saf. 2006; 29: 385-396.
- 30Howe CL. A review of the Office of Inspector General's reports on adverse event identification and reporting. J Healthc Risk Manage. 2011; 30: 48-54.
- 31Roulet L, Ballereau F, Hardouin JB, et al. Assessment of adverse drug event recognition by emergency physicians in a French teaching hospital. Emergency Med J. 2013; 30: 63-67.
- 32Tam VC, Knowles SR, Cornish PL, Fine N, Marchesano R, Etchells EE. Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. CMAJ. 2005; 173: 510-515.
- 33Hippisley-Cox J, Coupland C. Predicting risk of emergency admission to hospital using primary care data: derivation and validation of QAdmissions score. BMJ Open. 2013; 3:e003482.
- 34Nivya K, Sri Sai Kiran V, Ragoo N, Jayaprakash B, Sonal SM. Systemic review on drug related hospital admissions - a pubmed based search. Saudi Pharm J. 2015; 23: 1-8.
- 35Jatau AI, Shitu Z, Khalid GM, Yunusa I, Awaisu A. Understanding adverse drug-related emergency department visits: development of a conceptual model through a systematic review. Ther Adv Drug Saf. 2019; 10: 1–18.
- 36Zed PJ, Abu-Laban RB, Balen RM, et al. Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study. CMAJ. 2008; 178: 1563-1569.
- 37Hafner JW Jr, Belknap SM, Squillante MD, Bucheit KA. Adverse drug events in emergency department patients. Ann Emergency Med. 2002; 39: 258-267.
- 38Trifiro G, Calogero G, Ippolito FM, et al. Adverse drug events in emergency department population: a prospective Italian study. Pharmacoepidemiol Drug Saf. 2005; 14: 333-340.
- 39Asseray N, Ballereau F, Trombert-Paviot B, et al. Frequency and severity of adverse drug reactions due to self-medication: a cross-sectional multicentre survey in emergency departments. Drug Saf. 2013; 36: 1159-1168.
- 40Nickel CH, Ruedinger JM, Messmer AS, et al. Drug-related emergency department visits by elderly patients presenting with non-specific complaints. Scand J Trauma Resusc Emergency Med. 2013; 21: 15.
- 41Hohl CM, Nosyk B, Kuramoto L, et al. Outcomes of emergency department patients presenting with adverse drug events. Ann Emergency Med. 2011; 58: 270-279.e4.
