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Iatrogenic complications in high-risk, elderly patients
F Lefevre1, J Feinglass, S Potts
1Division of General Internal Medicine, Northwestern University Medical School, Chicago, IL 60611.
Archives of Internal Medicine
|October 1, 1992
Summary
Elderly patients with long hospital stays frequently experience iatrogenic complications. Improving initial physician assessment and documentation of functional status can prevent many of these adverse events in geriatric care.
Area of Science:
- Geriatric Medicine
- Patient Safety
- Quality Improvement
Background:
- Long-stay patients in elderly medicine services are at risk for complications.
- Focus on common conditions: congestive heart failure, myocardial infarction, pneumonia.
Purpose of the Study:
- Evaluate quality improvement potential in care for long-stay elderly patients.
- Identify factors contributing to iatrogenic complications.
Main Methods:
- Retrospective review of 120 medical records (patients >= 65 years, hospital stay >= 15 days).
- Assessed illness severity (Medicare Mortality Predictor System) and process quality (structured implicit review).
- Analyzed risk factors for iatrogenic events using logistic regression.
Main Results:
- 58.3% of patients experienced at least one iatrogenic complication.
- 35.8% of complications were potentially preventable.
- Key predictors included quality of initial physician assessment and patient's functional status (mobility, Glasgow Coma Score).
Conclusions:
- Iatrogenic complications are highly prevalent in long-stay elderly patients.
- Enhanced initial assessment and documentation of functional status are crucial for prevention.
- Quality of care ratings were not significantly affected by mortality or complications alone.