Addressing Postdischarge Adverse Events: A Neglected Area

Postdischarge safety is an area that has long been neglected. Recent studies from the United States and Canada found that about one in five patients discharged home from the general internal medicine services of major teaching hospitals suffered an adverse event. MEDLINE, Cochrane databases, and reference lists of retrieved articles were used in a literature search of articles published from 1966 through May 2007. Patient safety research has focused mostly on adverse events in hospitalized patients. Although some data are available about the ambulatory setting, even fewer studies have been done focusing on adverse events following hospital discharge. Only two studies conducted in North America have examined the incidence rate of all types of postdischarge adverse events. On the basis of the available evidence, key areas of opportunity to improve postdischarge care are as follows: (1) improving transitional care, (2) improving information transfer through strategic use of electronic health records, (3) medication reconciliation, (4) improving follow-up of test results, and (5) using screening methods to identify patients with adverse events. Limited evidence suggests that about one in five internal medicine patients suffers an adverse event after discharge from a North American hospital. The risk of postdischarge adverse events should be recognized by patient safety experts as an important area of concern.