Research published in the current issue of the Annals of Emergency Medicine reveals that emergency department (ED) patients who visit because of an adverse drug event (ADE) are significantly more expensive to the healthcare system than other ED patients. The research, done at Vancouver General Hospital, is the first of its kind to directly compare costs of the two groups.
Researchers found that while there was no difference in mortality rates between the two groups, the group with ADE had a 50% greater risk of spending additional days in the hospital, and a 20% greater need for outpatient healthcare.
The study controlled for baseline differences such as age, gender, previous health conditions, whether a patient was monitored by a primary care physician, and elicit drug use. One thousand Vancouver General Hospital ED patients were followed for six months.
"The most common events were adverse drug reactions. Those accounted for about 40% of all those events. Another 30% were attributed to non-compliance, "explained Corrine Hohl, MD, an emergency physician at Vancouver General Hospital and a researcher at the Centre for Clinical Epidemiology and Evaluation at Vancouver Coastal Health and the University of British Columbia, and the lead researcher on the study.
"The rest of the events," she said," were in several smaller subcategories such as prescribing errors, dispensing errors, an interaction with another drug, or inappropriate medication use given the patient's co-morbid conditions."
As for which medications were most commonly the culprits, Dr. Hohl said that antibiotics, analgesics, cardiovascular drugs, and drugs for hyperglycemia were commonly seen. "The general rule was that if it was commonly prescribed, we saw a lot of adverse drug events from it."
Although the research was done in Canada, the United States sees a significant amount of ADEs, too. The Agency for Health Care Quality and Research reports that more than 770,000 people die or are injured as a result of an ADE in American hospitals each year.
This costs each hospital an average of $5.6 million, depending on it size. Among other pieces of information, the agency reports that patients who experienced an ADE were hospitalized an average of 8 to 12 days longer than those who did not, and their hospitalizations cost $16,000 to $24,000 more.
Eric Lavonas, MD, an emergency physician from Denver Health and a spokesperson for the American College of Emergency Physicians believes the problem in the U.S. is worse than the research shows from Canada.
"Because this study was conducted in Canada, most of the patients had a primary care physician, and most received all their medication from a single doctor. But in the US, patients often see multiple specialists who do not coordinate care with each other or the primary care physician," Dr. Lavonas says. "As eye-opening as this study is, I'm sure that the opportunity for improvement is even greater in the US than this study shows."
Working with EDs, the research team is developing different strategies that will help them more quickly recognize drug-related adverse events.
"We are currently looking into a tool that nurses can use that will allow them to triage the patient and identify who the high risk patients are," Dr. Hohl said. "They will [ask] several questions that will classify the patient into a high or low risk group using variables such as the number of co-morbid conditions, if the patient has had a medication change, or been on antibiotics recently."
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