Article Figures & Data
Figures
- Figure 1.
Injury and mortality rates by comorbidity index.
- Figure 2.
Rates of mortality and drug- and procedure-related injury codes according to number of diagnostic fields used in each record
*Note: Diagnosis field #10 is exclusively an E code (cause of injury) though E codes can also appear in other diagnosis fields. For this field, the average number of E codes for drug injuries is 46.2, exceeding the limits of this graph.
- Figure 3.
Interrelationships among illness severity, medical care, injury, and death.
Tables
Characteristics Without Medical Injury (n = 484,650) With Medical Injury (n = 77,666) All differences statistically significant at P <.001. * Comorbidity index score, with possible range of scores 0.0–33.81; higher score indicates greater comorbidity.13 Mean age, years (± SD) 53.3 ± 24.7 59.2 ± 21.4 0–15, % 6.1 3.9 16–44, % 32.0 20.4 45–64, % 22.0 27.4 >65, % 39.9 48.3 Sex, female, % 60.2 54.8 Mean length of stay, days (± SD) 5.0 ± 5.6 8.0 ± 9.5 Comorbidity index, mean (± SD)* 1.00 ± 1.99 1.84 ± 2.61 Number of procedures, % 0 40.2 30.9 1 25.9 22.3 2 15.3 14.9 3 9.1 10.0 4 4.2 6.3 5 2.6 5.9 6+ 2.9 9.7 Procedure type, % No procedure 40.2 30.9 Operative only 7.1 5.7 Nonoperative only 41.3 42.9 Both 11.4 20.5 - Table 2.
Rates of Medical Injury, Mortality With and Without Medical Injury, Crude Risk Ratios, and Adjusted Odds Ratios for Mortality Associated With Each Broad Category of Injury and Overall
Measure Drugs and Biologics Devices, Implants and Grafts Procedures Radiation Overall * Total is less than sum of categories as some records include more than 1 injury code. † Adjusted for comorbidity index, age, sex, Diagnosis Related Group (as fixed effect), hospital characteristics (ownership, trauma level, residency training, percentage of board certified staff, transplant services, percentage of nonspecific coding), and clustering within hospital. ‡ P <.05. Number of discharges with medical injury code 33,787 17,146 33,578 1,545 77,666* Medical injury rate, % 6.01 3.05 5.97 0.27 13.81 Crude mortality rate among those with specific medical injury, % 2.84 3.52 3.54 5.44 3.14 Crude mortality rate among those without specific medical injury, % 2.23 2.23 2.19 2.26 2.13 Crude rate ratio (RR) 1.27 1.58 1.62 2.41 1.47 Adjusted odds ratio† (95% CI) 0.73‡ (0.66–0.81) 1.16‡ (1.03–1.30) 1.39‡ (1.28–1.52) 1.10 (0.91 – 1.34) 0.98 (0.91–1.06)
The Article in Brief
Background To improve safety, hospitals often rely on voluntary reporting of errors and near misses; however, many medical injuries occur during care that is appropriate. Identifying errors by focusing on patient health, rather than errors, can provide additional information about patient safety problems. This study uses such a model to identify medical injuries among patients discharged from Wisconsin hospitals and to estimate related deaths.
What This Study Found In 2002, 13.8% of patients in Wisconsin hospitals experienced a medical injury. Those who had a medical injury had a 48% higher risk of death. Medical injury and risk of in-hospital death were higher among older patients who had multiple medical conditions. Multiple medical conditions must be taken into account to avoid inflating estimates of in-hospital medical injuries.
Implications
- The number of deaths directly attributable to medical injury may not be as high as previously thought when the patient�s medical conditions are fully considered.
- Family physicians can help improve patient safety by assisting with hospitalization decisions, coordinating patients� care, and managing their chronic illnesses.
