Reporting adverse events at geriatric facilities: categorization by type of adverse event and function of reporting personnel.

PURPOSE: Adverse events and patient care-related adverse events are a challenging universal problem, among elder residents of geriatric facilities. The aim of this study was to examine which types of adverse events are characteristic of the geriatric center studied and which of the nursing staff reported this event. DESIGN/METHODOLOGY/APPROACH: Data were retrieved from the computerized adverse event management system at a large geriatric center in central Israel, and all adverse events reported over the past three years were examined. FINDINGS: The study findings indicate that the most common type of adverse event was falls. Older nurses with greater seniority in the facility show a higher tendency to report adverse events. In addition, registered nurses were found to report more often than practical nurses. PRACTICAL IMPLICATIONS: This study highlights the important role that nurses can play in reporting and reducing adverse events. The role of the nurse is becoming increasingly complex, especially in geriatric facilities, which serve people with complex mental and physical states who are more susceptible to adverse events to begin with. ORIGINALITY/VALUE: Despite the large number of adverse events, few studies have been undertaken on adverse events in geriatrics in general, and in nursing homes and long-term facilities in particular. Answers to these questions will enable improvement in the quality of care provided and ensure a safe care environment for residents. Systematically examining types of adverse events and the characteristics of those who do and do not report them, can contribute to improvement of processes in the healthcare system in general, and in the facility in particular. Additionally, efficient investigation can improve the behavior of those who enable adverse events.

[Characteristics of emergency room admissions of IDF soldiers in northern Israeli hospitals between May 2002 and April 2003].

BACKGROUND: The hospitalization rate of patients visiting the emergency room depends on various parameters including demography, clinical data and other variables. Long term follow-up of hospitalized IDF soldiers reflected variability in hospital admission rate among hospitals and raises the possibility of vastly inappropriate hospitalizations. AIM: The aim of this study was to characterize the admission policy for IDF soldiers in various hospitals, to assess the rate of inappropriate hospitalizations, and to evaluate these costs to the Medical Corps. METHODS: Three hospitals in northern Israel were screened between May 2002 and April 2003, one urban tertiary care hospital (A) and two rural hospitals of different sizes (B and C). One fifth of the discharge forms were randomly screened. Every admission was given a risk evaluation based only on clinical data found upon presentation in the emergency room. One abnormal finding rendered the admission to be considered as appropriate. The rate of admission, lengths of stay, as well as clinical data and utilization of diagnostic tests were recorded and compared. RESULTS: During the study period 65 +/- 1105, 39 +/- 536, and 54 +/- 485 Emergency Room visits were made monthly in hospitals A, B and C, respectively. A total of 1.0% +/- 6.5. 1.4% +/- 12.6 and 2.7% +/- 11.8 of these visits resulted in hospitalization in hospitals A, B and C, respectively. Approximately one quarter of the patients admitted to hospital A were low risk, compared to more than half in the rural hospitals. Low risk admissions were one day shorter in the urban hospital, whereas high risk admissions had the same length of stay. The cost of low risk admissions in the urban hospital was about half of its cost in any of the rural hospitals. The estimated annual cost of low risk admission in all three hospitals screened was about $US 1 million. CONCLUSIONS: The admission rate in the urban hospital was half of its rate in the rural hospitals. Overall, 27% less low risk admissions were made in the urban hospital. The rural hospitals tendency to admit more low risk patients was compounded with their tendency to lengthen these admissions. The reason for this behaviour is not clear, although it may be related to differences in experience and clinical knowledge, consideration of the distance between the hospital and the soldier's home or unit, and financial admission policies.