Multidisciplinary Treatments, Patient Characteristics, Context of Care, and Adverse Incidents in Older, Hospitalized Adults

The purpose of this study was to examine factors that contribute to adverse incidents by creating a model that included patient characteristics, clinical conditions, nursing unit context of care variables, medical treatments, pharmaceutical treatments, and nursing treatments. Data were abstracted from electronic, administrative, and clinical data repositories. The sample included older adults hospitalized during a four-year period at one, academic medical facility in the Midwestern United States who were at risk for falling. Relational databases were built and a multistep, statistical model building analytic process was used. Total registered nurse (RN) hours per patient day (HPPD) and HPPDs dropping below the nursing unit average were significant explanatory variables for experiencing an adverse incident. The number of medical and pharmaceutical treatments that a patient received during hospitalization as well as many specific nursing treatments (e.g., restraint use, neurological monitoring) were also contributors to experiencing an adverse incident. 1. Background The Institute of Medicine (IOM) report To Err is Human [1] revealed the number and significance of adverse events and errors that occur during hospitalization. The report was a call to action to transform healthcare systems to ensure patient safety and higher quality care. In one step toward healthcare transformation, the Centers for Medicare and Medicaid (CMS) no longer reimburses institutions for the care, or treatment, associated with certain hospital-acquired conditions [2]. Understanding what factors contribute to adverse incidents during hospitalization is essential to developing effective counter measures. In order to improve factors that are modifiable within a hospital structure or with healthcare delivery, it is important to first have an understanding of what is broken. There are a number of potential contributing factors that need to be considered such as the patient’s condition, the care the patient receives, and the environment in which they receive care [3, 4]. Battles and Lilford [3] provide a conceptual model for patient safety that includes antecedent conditions, which would include the patient’s comorbid conditions, the primary reason the patient was admitted to the hospital, and characteristics the patient possessed before entering the hospital. Their model also includes the structure, or environment, in which the patient receives care such as the hospital, or nursing unit. Also acting within the structure are the processes of care (the interventions or treatments)