General Hospital Psychiatry
Volume 32, Issue 4 , Pages 419-425, July 2010

National estimates of adverse events during nonpsychiatric hospitalizations for persons with schizophrenia☆☆☆

  • Elizabeth Khaykin, Ph.D., M.H.S., S.M.

      Affiliations

    • Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
    • Corresponding Author InformationCorresponding author. Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD 21287, USA. Tel.: +1 410 502 8893; fax: +1 410 955 0476.
    • ,
  • Daniel E. Ford, M.D., M.P.H.

      Affiliations

    • Department of Medicine, Johns Hopkins University School of Medicine, and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
    • ,
  • Peter J. Pronovost, M.D., Ph.D.

      Affiliations

    • Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, MD, USA
    • Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
    • Department of Health Policy and Management, The Johns Hopkins University, Baltimore, MD, USA
    • Division of Adult Critical Care, The Johns Hopkins University, Baltimore, MD, USA
    • Center for Innovation in Quality Patient Care, Johns Hopkins Medicine, Baltimore, MD, USA
    • ,
  • Lisa Dixon, M.D., M.P.H.

      Affiliations

    • Mental Illness Research, Education and Clinical Center (MIRECC), VA Capitol Health Care Network, and the University of Maryland School of Medicine, Baltimore, MD, USA
    • ,
  • Gail L. Daumit, M.D., M.H.S.

      Affiliations

    • Johns Hopkins Medical Institutions, Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA

Received 5 February 2010; accepted 21 April 2010. published online 04 June 2010.

Abstract 

Objective

Persons with schizophrenia comprise a vulnerable population that may be disproportionately susceptible to medical injuries. The objective of this study was to determine the association between diagnosis of schizophrenia and adverse events during non-psychiatric hospitalizations.

Methods

We studied U.S. hospital discharges from 2002-2007 using the Nationwide Inpatient Sample. We determined the nationally weighted association of schizophrenia with the Agency for Healthcare Research and Quality's Patient Safety Indicators after adjusting for patient, hospitalization, and hospital characteristics.

Results

There were 269,387 non-psychiatric hospitalizations with schizophrenia, and 37,092,651 without. Hospitalizations with schizophrenia had elevated adjusted odds ratios for PSIs compared with those without schizophrenia for decubitus ulcer (1.43, 95% CI: 1.36-1.51); infection from medical care (1.19, 95% CI: 1.08-1.30); postoperative respiratory failure (1.96, 95% CI: 1.67-2.30); sepsis (1.59, 95% CI: 1.25-2.02); and pulmonary embolism/deep venous thrombosis (1.23, 95% CI: 1.13-1.35). Adjusted odds ratios for iatrogenic pneumothorax (1.12, 95% CI: 0.94-1.33) and postoperative hemorrhage (1.07, 95% CI: 0.88-1.31) were not significantly different in persons with schizophrenia, while the adjusted OR for accidental puncture (OR=0.66, 95% CI: 0.58-0.74) was reduced in persons with schizophrenia.

Conclusions

Persons with schizophrenia are more likely to experience the most common types of medical injuries. Improved understanding of factors related to hospital quality of care and outcomes in this group will be important to plan interventions to enhance patient safety for persons with schizophrenia.

Keywords: Schizophrenia, Vulnerable populations, Patient safety, Medical errors, Administrative data

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☆ Disclosure of funding: This study was funded through the NARSAD Young Investigator Award and there are no conflicts of interest or financial disclosures.

☆☆ A version of “National Estimates of Adverse Events in Persons With Schizophrenia” was presented on April 8, 2009, in B14B Hampton House, Johns Hopkins School of Public Health as part of a Department of Mental Health seminar. The data presented was not updated for the latest available year of the Nationwide Inpatient Sample.

PII: S0163-8343(10)00096-4

doi:10.1016/j.genhosppsych.2010.04.006

Refers to erratum:

  • Erratum to “National estimates of adverse events during nonpsychiatric hospitalizations for persons with schizophrenia” [General Hospital Psychiatry 32 (2010) 419–425] , 25 October 2010

    Elizabeth Khaykin, Daniel E. Ford, Peter J. Pronovost, Lisa Dixon, Gail L. Daumit
    General Hospital Psychiatry November 2010 (Vol. 32, Issue 6, Page 644)

General Hospital Psychiatry
Volume 32, Issue 4 , Pages 419-425, July 2010

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