A 68-year-old man with coronary artery disease is admitted after 4 weeks of shortness of breath and lower-extremity swelling. He has suffered 2 prior myocardial infarctions and has been diagnosed with persistent atrial fibrillation, hypertension, and type 2 diabetes mellitus. The patient's blood pressure is 132/80 mm Hg and his heart rate is 122/min. On physical examination, he has bibasilar crackles, a third heart sound, and 2+ peripheral edema. This patient is most likely to suffer which of the following adverse in-hospital events?

Question

A 68-year-old man with coronary artery disease is admitted after 4 weeks of shortness of breath and lower-extremity swelling.  He has suffered 2 prior myocardial infarctions and has been diagnosed with persistent atrial fibrillation, hypertension, and type 2 diabetes mellitus.  The patient's blood pressure is 132/80 mm Hg and his heart rate is 122/min.  On physical examination, he has bibasilar crackles, a third heart sound, and 2+ peripheral edema.  This patient is most likely to suffer which of the following adverse in-hospital events?

Quizplus · Accepted Answer

Explanation: Adverse events occur in approximately 5%-15% of hospitalized patients, although these numbers appear to be decreasing and vary significantly depending on how an adverse event is defined. Multiple studies have been performed to analyze the incidence of various types of adverse events. These events can be grouped into 4 broad categories: operative and post-procedure, adverse drug, and general care (eg, falls, pressure ulcers) events, and hospital-acquired infections. The most common adverse events in hospitalized patients, such as wound infections, bleeding, or deep venous thrombosis, are related to surgery. In patients not undergoing surgery, the largest group is adverse drug events (ADEs), which are commonly related to use of hypoglycemic agents, anticoagulants, antibiotics, or analgesics. ADEs are estimated to occur in slightly over 5%-7% of all hospitalized patients and account for almost one-fifth of all adverse events in some studies. (Choice B) The risk of falls may be as high as 5%-10% in certain hospitalized populations, such as patients with stroke or in geriatric psychiatry units, but falls account for only 1%-2% of adverse events in the general hospital population. (Choice C) Among the most important hospital-acquired infections are urinary tract infections, pneumonia, and Clostridium difficile diarrhea. Hospital-acquired infections occur in approximately 4% of patients and represent the second largest category of adverse events in hospitalized medical patients. (Choice D) Pressure ulcers occur in approximately 1%-5% of hospitalized patients and are fairly evenly distributed among surgical and medical patients. (Choice E) In a patient with a likely exacerbation of congestive heart failure, there is minimal likelihood of an invasive procedure being performed; procedures on the wrong site are relatively rare occurrences. Educational objective: Adverse events occur in 5-15% of hospitalized patients and can be grouped into 4 broad categories: operative and post-procedure, adverse drug, and general care events, and hospital-acquired infections. Among patients not undergoing surgery, the most frequent adverse events are adverse drug events, which account for almost one-fifth of all events. References: The incidence and nature of in-hospital adverse events: a systematic review. (http://www.ncbi.nlm.nih.gov/pubmed/18519629) The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. (http://www.ncbi.nlm.nih.gov/pubmed/15159366) Incidence and types of adverse events and negligent care in Utah and Colorado. (http://www.ncbi.nlm.nih.gov/pubmed/10718351)

A 68-Year-Old Man with Coronary Artery Disease Is Admitted After