Medical errors related to discontinuity of care from an inpatient to an outpatient setting

Abstract

Objective: To determine the prevalence of medical errors related to the discontinuity of care from an inpatient to an outpatient setting, and to determine if there is an association between these medical errors and adverse outcomes.

Patients: Eighty-six patients who had been hospitalized on the medicine service at a large academic medical center and who were subsequently seen by their primary care physicians at the affiliated outpatient practice within 2 months after discharge.

Design: Each patient's inpatient and outpatient medical record was reviewed for the presence of 3 types of errors related to the discontinuity of care from the inpatient to the outpatient setting: medication continuity errors, test follow-up errors, and work-up errors.

Measurements: Rehospitalizations within 3 months after the initial postdischarge outpatient primary care visit.

Main results: Forty-nine percent of patients experienced at least 1 medical error. Patients with a work-up error were 6.2 times (95%confidence interval [95% CI], 1.3 to 30.3) more likely to be rehospitalized within 3 months after the first outpatient visit. We did not find a statistically significant association between medication continuity errors (odds ratio [OR], 2.5; 95%CI, 0.7 to 8.8) and test follow-up errors (OR, 2.4; 95%CI, 0.3 to 17.1) with rehospitalizations.

Conclusion: We conclude that the prevalence of medical errors related to the discontinuity of care from the inpatient to the outpatient setting is high and may be associated with an increased risk of rehospitalization.

Figures

FIGURE 1

Medication continuity error chart abstraction algorithm. D/C, discharge.aNo patients excluded from the study. bOne patient excluded from the study.

FIGURE 2

Test follow-up error chart abstraction algorithm. D/C, discharge.

FIGURE 3

Work-up error chart abstraction algorithm. D/C, discharge.