Distance from hospital impacts adverse event detection

Post written by Rajesh N. Keswani, MD, MS, from the Northwestern University Feinberg School of Medicine.

Keswani_headshotThe objective of this study was to determine the hospital utilization patterns of patients with endoscopy-related adverse events (AEs), including death, after ambulatory endoscopy at 5 Chicago-area medical centers. We specifically aimed to investigate whether care fragmentation, which is common at academic medical centers, significantly impairs our ability to track AEs in an automated fashion (i.e., counting index hospital re-admissions).

Recently published joint American Society for Gastrointestinal Endoscopy/American College of Gastroenterology quality guidelines recommend that all endoscopy units measure adverse event (AE) incidence after GI endoscopy. However, we hypothesized that monitoring for AEs is challenging at referral hospitals where patients may travel long distances for their complex endoscopic care. If a delayed AE occurs, these patients may not present back to the index hospital and, thus, may be “lost” to follow-up if they are not systematically contacted.

This study leveraged a unique database, the HealthLNK Data Repository (HDR). The HDR is an assembly of electronic health records from area healthcare institutions, utilizing a software application for de-duplication and integration of de-identified, patient-level clinical data across institutions; the HDR was developed through collaboration of 7 area hospitals.

During the 2-year study period, 42,842 ambulatory endoscopies were performed in 22,898 unique individuals. Nearly half (42%) of patients with early mortality (within 30 days) after ambulatory endoscopy were not re-hospitalized at the index hospital following endoscopy. Furthermore, patients who did not return to the index hospital before death were less likely to receive their outpatient care at the index hospital and lived significantly farther from the index hospital.

Similarly, the observed rate of potential AEs trended downward as patients’ home zip codes moved farther from the index hospital (Figure 2). In summation, these findings suggest that patients who live farther away from the hospital where their endoscopy is performed are less likely to return to that index hospital for emergency care.

Keswani_fig

Figure 2. Observed adverse event rate, as measured at the index hospital, decreases as distance from patients’ home zip codes to index hospital increases.
Each point represents the proportion of the total adverse event rate seen at each distance quartile (the total for each procedure equaling 100%). *P < .05.

Given the volume of endoscopic procedures, an automated system to track AEs (based on re-admissions to the hospital after endoscopy) is ideal. However, this type of tracking critically will not account for an unplanned hospital visit or AE presenting to an outside ED. This study confirms that obtaining an accurate measurement of AE rates and mortality after outpatient endoscopy cannot rely only on tracking encounters at the index hospital, because a significant number of patients may seek care elsewhere after endoscopy. Because calling patients is also burdensome and inaccurate, novel methods to measure AE rates after endoscopy are required.

Find the article abstract here.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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