Inpatient patient safety events in vulnerable populations: a retrospective cohort study

Lucy B Schulson; Victor Novack; Patricia H Folcarelli; Jennifer P Stevens; Bruce E Landon

doi:10.1136/bmjqs-2020-011920

Inpatient patient safety events in vulnerable populations: a retrospective cohort study

BMJ Qual Saf. 2020 Oct 26:bmjqs-2020-011920. doi: 10.1136/bmjqs-2020-011920. Online ahead of print.

Authors

Lucy B Schulson^{1

2}, Victor Novack^{3

4}, Patricia H Folcarelli^{5

6}, Jennifer P Stevens^{3

7}, Bruce E Landon^{3

6

8}

Affiliations

¹ General Internal Medicine, Boston Medical Center, Boston, MA, USA schulson@rand.org.
² The RAND Corportation, Boston, MA, USA.
³ Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, USA.
⁴ Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
⁵ Health Care Quality, Beth Israel Deaconess Medical Center, Boston, MA, USA.
⁶ Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
⁷ Division for Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
⁸ Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.

PMID: 33106277
DOI: 10.1136/bmjqs-2020-011920

Abstract

Background: Widespread attention to structural racism has heightened interest in disparities in the quality of care delivered to racial/ethnic minorities and other vulnerable populations. These groups may also be at increased risk of patient safety events.

Objective: To examine differences in inpatient patient safety events for vulnerable populations defined by race/ethnicity, insurance status and limited English proficiency (LEP).

Design: Retrospective cohort study.

Setting: Single tertiary care academic medical centre.

Participants: Inpatient admissions of those aged ≥18 years from 1 October 2014 to 31 December 2018.

Measurements: Primary exposures of interest were self-identified race/ethnicity, Medicaid insurance/uninsured and LEP. The primary outcome of interest was the total number of patient safety events, defined as any event identified by a modified version of the Institute for Healthcare Improvement global trigger tool that automatically identifies patient safety events ('automated') from the electronic record or by the hospital-wide voluntary provider reporting system ('voluntary'). Negative binomial models were used to adjust for demographic and clinical factors. We also stratified results by automated and voluntary.

Results: We studied 141 877 hospitalisations, of which 13.6% had any patient safety event. In adjusted analyses, Asian race/ethnicity was associated with a lower event rate (incident rate ratio (IRR) 0.89, 95% CI 0.83 to 0.96); LEP patients had a lower risk of any patient safety event and voluntary events (IRR 0.91, 95% CI 0.87 to 0.96; IRR 0.89, 95% CI 0.85 to 0.94). Asian and Latino race/ethnicity were also associated with a lower rate of voluntary events but no difference in risk of automated events. Black race was associated with an increased risk of automated events (IRR 1.11, 95% CI 1.03 to 1.20).

Limitations: This is a single centre study.

Conclusions: A commonly used method for monitoring patient safety problems, namely voluntary incident reporting, may underdetect safety events in vulnerable populations.

Keywords: hospital medicine; incident reporting; patient safety.