Adverse events following an emergency department visit

Many studies demonstrate a high rate of treatment-related adverse outcomes or adverse events. No studies have prospectively evaluated adverse events in patients discharged home from the emergency department (ED).

To describe the types of adverse events in patients discharged home from an ED.

PATIENTS who were sent home directly from the ED of an urban, academic teaching hospital in Ottawa, Canada.

Patient records were reviewed to identify demographic and medical history information. Two weeks following the ED visit, patients completed a standard telephone interview to record post ED visit outcomes. Two physicians reviewed outcomes to identify all adverse events and their cause.

Follow-up was complete for 399 of 408 enrolled patients. The median age was 49 years (interquartile range 36-68) and 50% were male. The most common diagnosis was "chest pain", occurring in 74 patients (18%), followed by "bone and joint disorders" in 55 patients (14%). 24 patients experienced an adverse event (incidence 6% (95% CI 4% to 9%)), of which 17 were preventable (incidence 4% (95% CI 3% to 7%)). Five of the unpreventable adverse events were medication side effects and two were minor, procedure-related complications. Of all 24 adverse events, 15 (63%; 95% CI 43 to 79%) led to an additional ED visit or a hospitalisation. Preventable adverse events occurred in 5 of 78 chest pain patients (incidence 6% (95% CI 3% to 14%)).

Most adverse events occurring following an ED visit are preventable and often relate to diagnostic or management errors.