The purpose of this study was  to compare the impact of an adverse event alert system (ADE) on patient outcomes prior to and after the ADE was deployed and  determine if drilldowns could be made into determining which events, medications or patients,if any, benefit most.
All inpatients consecutively admitted (N=160,411) to 7 Trinity Health hospitals which implemented the ADE were studied. Two who did not were used as external controls. Cases 1 year prior to the go-live date at each site were compared with cases after the go live date. 22,100 patients were identified as having triggered one of 17 alerts. These alerts were triggered using a Trinity Health generated computerized algorithm examining demographic, medication and clinical lab values. Outcome measures studied included changes in LOS, mortality, pharmacy and variable drug costs and total costs.
The two timeframes, exhibited statistically different outcomes. Adjusting for severity post-verification, LOS was 2% less (p <.000). Similarly, severity adjusted mortality ratios were significantly different: 1.049 pre versus .975 post (p <.002). The severity-adjusted ratio of overall costs found that the post-ADE group was 3% higher (P <.000) yet the pharmacy costs were 8.7% lower (p <.000). The pharmacy cost reduction in the Post-ADE hospitals exceeded $8M. Both internal and external control groups demonstrated no such changes. Specific subgroups (open heart hospitals) were most likely to benefit from ADE implementation.
ADE alert firings are consistently associated with increased costs, LOS and mortality. Patients experiencing such alerts exhibited significantly more severity of illness. Specific medication types appear to be related to outcomes. Given the numerous alerts fired, previous ADE alert savings estimates seem high. This study suggests the implemention an ADE system, more so than the individual alerts themselves, resulted in desired outcomes as evidenced by slightly decreased LOS and reduced hospital mortality rates; with significant pharmacy cost and variable drug cost reductions.
Systems developed to improve patient safety appear to improve quality and reduce costs.
F. Piontek, None.