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Changes In The Health Care System Are Needed To Prevent Complications After Discharge From Hospital
First-of-a-kind report argues need for better continuity of care

OTTAWA, February 2, 2004 More than one in five patients experience complications after discharge from hospital, and half of those could be prevented or made less serious, suggests a landmark study conducted by researchers at The Ottawa Hospital.

"Patient safety is a priority for The Ottawa Hospital," said Dr. Jack Kitts, President and CEO of the Hospital. "The hospital believes that the findings from this study will help health care providers across Canada learn more about patient safety and will encourage more collaborative efforts to improve patient safety."

Until now, there have been no systematic Canadian analyses of preventable complications for patients once they leave the hospital. The research study conducted by Dr. Alan Forster and his team is part of a comprehensive Patient Safety Strategy at The Ottawa Hospital. By better understanding what complications are occurring for patients, and what is causing them, hospitals across Canada can more precisely target improvement efforts.

Dr. Forster has shared early results of his research previously with hospital staff and this has guided efforts to improve patient safety at The Ottawa Hospital. Measures taken include:
  • Developing a nursing coordinator role to work with patients during discharge to ensure that the right supports are in place to prevent complications from happening once they return home;
  • Improving the availability of health information through the creation of electronic health records that are accessible to community providers who have privileges at The Ottawa Hospital;
  • Making sure that patients leave the hospital with the right information for their physicians about the kind of ongoing care they require;
  • Improving telephone follow-up with patients once they leave the hospital.

"There is strong evidence from other research that lapses in patient safety that are usually not a function of 'bad hospitals' or 'bad providers'," said Dr. Kitts. "Instead, this evidence suggests that the problems are related to how the health care system is organized and where there needs to be stronger levels of collaboration and communications between the parts of the system."

The study is one of the first in Canada and one of the firsts in the world to assess adverse events after hospital discharge. It appears in the February 3, 2004 edition of the Canadian Medical Association Journal.

The Study (Adverse Events Among Medical Patients After Discharge from Hospital)

The study looked at the experience of 300 patients discharged from the medical ward of The Ottawa Hospital during a 14-week period in 2002. Nearly three-quarters of the complications observed were due to medication-related side effects.

The researchers drew two important conclusions in their study. "First, patients should be followed more closely after they are discharged from hospital," said lead investigator Dr. Alan Forster, an Internal Medicine specialist at TOH and Affiliate Scientist at the Ottawa Hospital Research Institute. "Improved communication with community providers, better integration of home care services with hospital care, hospital-based follow-up clinics, and early telephone contacts are all part of a possible solution."

A second major finding is that the frailty of patients led to challenges in follow-up care. "A quarter of the patients we observed were over 81 years of age; most of them had several medical conditions; and, one out of five had at least one dependency in their activities of daily living," said Dr. Forster. "These are all factors that make them more likely to have complications."

While half the patients in this study who had complications recovered on their own, the other half required some type of additional care such as seeing their family doctor, a visit to the emergency department or re- admission to hospital. This shows that these post-discharge complications not only negatively impact the well-being of patients but that they also put additional stress on a healthcare system.

Issues identified in this study are not limited to the Canadian health care system. "A few years ago, we did a similar study of a hospital in the U.S. that is consistently ranked as one of the top 10 hospitals in the country and observed very similar results," said Dr. Forster, who is also an Associate Professor at the University of Ottawa. "The patients in our Canadian study were actually much sicker, and somewhat older, yet our complications rate post-discharge was similar," he added.

"Since the early results of this study were shared with us, our hospital has taken a number of steps to improve discharge planning and enhance communication post-discharge," said Wendy Nicklin, Vice- President responsible for Patient Safety at The Ottawa Hospital and a founding Board member of the Canadian Patient Safety Institute. "Nevertheless there continues to be a need for all of us in the health care system to make improvements in this area, and we'll have to work even closer together to make it happen," she added.

While Dr. Forster believes that health care providers must improve their systems to reduce the frequency and severity of complications following hospital discharge, he believes that patients also have a role to play. "An informed patient or caregiver reduces his or her chances of complications," says Dr. Forster.

He offers these tips to patients: "As a patient, you should know what your health problems are, what medications you're taking, what the potential side effects are, what to watch for, and who to call for follow- up or if things go wrong. Never hesitate to ask questions of your doctor or care provider both before and after discharge."

This research is made possible thanks to the generous support of the Ottawa Internists Research Group at The Ottawa Hospital and the Ontario Premier's Research Excellence Award.

About The Ottawa Hospital:

The Ottawa Hospital is a multi-campus academic health sciences centre. With over 1000 beds, 10,000 staff plus 1200 physicians, and an annual operating budget of approximately $600 million, it is one of the largest healthcare organizations in Canada.

In collaboration with the Ottawa Hospital Research Institute and the University of Ottawa, the Hospital is dedicated to excellence in patient care, to the education of future healthcare professionals, and to research resulting in bench-to-bedside discoveries.

The Ottawa Hospital partners with various organizations to provide comprehensive, high quality, patient- focused healthcare services, in English and French, to over 1.5 million residents of eastern Ontario, and specialized and complex services for residents of northeastern Ontario.

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The Ottawa Hospital
Ron Vezina
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613-737-8460 (After hours call 613-722-7000 and request on-call Media Relations staff)

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