Issue: 2013 > January > special article

Registering complications at admission via the emergency department: an opportunity for improvement

F.J.H. Magdelijns, D. Gulikers, E. Pijpers, R.P. Koopmans, P.M. Stassen


Background: To monitor and improve the quality of care
we provide it is important to register complications.
Complications occurring after discharge or after
treatment at outpatient clinics are usually not registered
and complications occurring in domains other than where they originated may be missed. The emergency
department (ED) may offer an opportunity to register these complications. This study assesses the prevalence and nature of complications in patients at the moment of acute admission by internists. Methods: A retrospective cohort study over a five-month period was performed in which we reviewed the charts of all patients who were admitted to our hospital via the ED by internists. We investigated the number, nature, preventability and severity of complications present at the moment of admission. Results: In total, there were 1128 admissions. Of these, 284 patients were admitted 324 times (28.7%) due to a complication. The most common complication was medication-related (43.5%), in particular bleeding while using anticoagulants. The second most prevalent complication was chemotherapy-related (26.9%), while 17.3% were due to a procedure. Up to 27.8% of all complications were considered preventable. Eighteen (6.3%) patients died during their admission, seven (2.5%) did not recover completely. A total of 23.1% of all complications originated in specialities other than internal medicine. Conclusion: Complications are a major reason for hospitalisation. Registering complications present at admission gives broad insight into the complications following the care doctors provide. It is important to understand these complications better to prevent such admissions.