VHA psychiatric units have lower rates of patient safety events than general hospitals

Inpatient psychiatric units at Veterans Health Administration (VHA) medical centers have lower rates of adverse events and medical errors, compared to psychiatric units at general hospitals, reports a study in the November issue of Medical Care. The journal is published in the Lippincott portfolio by Wolters Kluwer.

"Findings suggest that safety-oriented patient care processes at VHA facilities may serve as a model for safety improvement at community-based hospitals," according to the new research, led by Steven C. Marcus, PhD, of the School of Social Policy and Practice, University of Pennsylvania, Philadelphia. But the researchers emphasize the need for ongoing efforts to reduce adverse events on psychiatric units in all hospitals.

Safety events about half as frequent on VHA psychiatric units

Researchers analyzed medical records to compare rates of patient safety events, including adverse events and medical errors, in psychiatric units at VHA versus community hospitals. The study included approximately 8,000 patients discharged from 40 VHA hospitals and 4,440 patients discharged from 14 community-based general hospitals in Pennsylvania.

Adverse events were defined as harm or injury resulting from the negative unintended consequences of clinical care. Medical errors were defined as the omission or commission of clinical care with potentially negative consequences, regardless of whether or not the patient was harmed.

Records were screened for a broad range of patient safety events, including some common to all hospitalized patients (such as falls) and others more likely to occur for psychiatric inpatients (such as self-harm or injury). Due to differences in medical records, the study did not include medication errors. Adverse drug events and patient falls were the most common types of patient safety events.

Adverse events occurred at a rate of approximately 13.5 per 100 patient discharges at community hospitals, compared to 7 per 100 at VA hospitals. The rate of medical errors was about 1.5 versus 3 per 100, respectively. "Even after controlling for differences in patient and hospital characteristics, patients treated at community-based hospitals were approximately twice as likely as patients at VHA hospitals to experience adverse events or medical errors," Dr. Marcus and coauthors write.

Reducing adverse events and medical errors is a major focus of efforts to improve patient safety in medical care. Studies of the frequency of these events have often excluded patients with psychiatric disorders and hospital-based mental health care – despite the fact that there are more than 1 million annual discharges from US inpatient psychiatric units. The new study is among the first to compare safety outcomes for patients admitted to psychiatric units at VHA versus community hospitals.