To analyze the patterns of potentially avoidable readmissions due to adverse drug events (ADEs) to identify the most appropriate risk reduction interventions.
In this observational study, we analyzed a random sample of 534 potentially avoidable 30-day readmissions from 10,275 consecutive discharges from the medical department of an academic hospital. Readmissions due to ADEs were reviewed to identify the causative drugs and the severity and interventions to prevent them.
Seventy cases (13.1%) of readmission were partially or predominantly due to ADEs, of which, 58 (82.9%) were serious ADEs. Overall, 65 (92.9%) of the ADEs have been confirmed to be preventable. Inappropriate prescribing was identified as the cause of ADE in 34 cases (48.6%) mainly involving diuretics, analgesics, or antithrombotics: misprescribing n = 19 (27.1%), underprescribing n = 8 (11.4%), and overprescribing n = 7 (10.0%). The remaining half of preventable ADEs (n = 36; 51.4%) were related to suboptimal patient monitoring/education, such as adherence issues (n = 6; 8.6%) or lack of monitoring (n = 31; 44.3%). In 64 cases (91.4%), the readmission could have been potentially prevented by better monitoring for drug efficacy/disease control, or for predictable side effect. Thirty-three (97.1%) of the 34 ADEs due to inappropriate prescribing could have also been prevented by better monitoring.
Adverse drug events accounted for approximately 13% of 30-day preventable readmissions. A half were due to prescription errors involving mainly diuretics, analgesics, or antithrombotics, and the other half were due to suboptimal patient monitoring/education, most frequently with antineoplastics. Both these avoidable causes may represent opportunities to reduce the total drug-related adverse events.
From the *Hospital Medicine Service, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital; †Harvard Medical School, Boston, Massachusetts; ‡Louvain Drug Research Institute, Clinical Pharmacy Research Group, Université catholique de Louvain (UCL); §Cliniques universitaires Saint-Luc (UCL), Brussels, Belgium; ∥Research Center for Medical Informatics, University Hospital Zurich; and ¶Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland.
Correspondence: Olivia Dalleur, MPharm, PhD, Université catholique de Louvain, Louvain Drug Research Institute, Clinical Pharmacy Research Group Cliniques Universitaires Saint-Luc (UCL), Pharmacy Department, Avenue Hippocrate 10, 1200 Brussels, Belgium (e-mail: Olivia.Dalleur@uclouvain.be).
The authors disclose no conflict of interest.
Disclosures: O.D. was supported by the Fondation Saint-Luc. The Fondation Saint-Luc is the support unit of the Cliniques Universitaires Saint-Luc in charge of developing education and research projects of the hospital by collecting gifts from corporation, foundations, and alumni. The Fondation Saint-Luc had no role in the design and conduct of this study, analysis or interpretation of the data, or preparation of this abstract. P.E.B. was supported by the Swiss National Science Foundation. The funding source played no role in the design and conduct of this study; collection, management, and analysis of the data; interpretation of the results; and review and approval of the abstract. J.D. was supported by the Swiss National Science Foundation and the Swiss Foundation for Medical-Biological Scholarships. The Swiss Science National Foundation and the Swiss Foundation for Medical-Biological Scholarships had no role in the design and conduct of this study, analysis or interpretation of the data, or preparation of this manuscript. J.D. was a consultant to Profility, LLC, and to Homeward Health, Inc.
Authors’s Contribution: J.D. designed the study. O.D. participated in its design and coordination. O.D., P.E.B. and J.D. participated in the data collection and analysis. O.D. and J.D. performed the statistical analyses and wrote the first draft of the manuscript. All authors made critical revision of the manuscript and approved the final manuscript.