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Professor, Melbourne School of Health Sciences, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria, Australia
Senior Research Fellow, Melbourne School of Health Sciences, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne
Honorary Senior Fellow, Department of Medicine, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne
Statistical Consultant, Statistical Consulting Centre, Department of Mathematics and Statistics, The University of Melbourne
Reprints: Dr. Manias, Melbourne School of Health Sciences, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Level 5, 234 Queensberry St., Carlton, Victoria 3053, Australia, fax 61 3 9317 4375, emanias{at}unimelb.edu.au.
BACKGROUND: As patients move across transition points of care, medication discrepancies are likely to occur. In the emergency department (ED), patients are vulnerable to medication discrepancies because they are in an environment in which rapid decisions need to be made under high levels of stress.
OBJECTIVE: To identify the patient-, environment-, and medication-related factors involving unexplained medication discrepancies across transition points after ED presentation.
METHODS: Using a retrospective chart review design, a stratified, random sampling of data was undertaken over a 12-month period. Information was obtained from an electronic administrative database and medical records as patients moved from the ED to another transition point of care. Medication discrepancies were classified into 2 outcome groups: (1) no discrepancies and situations in which discrepancies were adequately explained and (2) discrepancies that had no adequate explanation.
RESULTS: For the 12-month period, 210 randomly selected patients were included; 73 (34.8%) had at least one unexplained medication discrepancy. Binary logistic regression modeling showed 4 factors that were statistically significant in determining the incidence of at least one unexplained medication discrepancy. Benefit card holders (individuals who receive benefits from government insurance programs comparable to the US-based Medicare and Medicaid initiatives, which include the elderly, the disabled, low income earners, and unemployed persons) had 3.73 greater odds of experiencing an unexplained medication discrepancy (95% CI 1.72 to 8.07; p = 0.001). Patients prescribed 5 or more drugs at discharge from the ED had 12.22 greater odds of having at least one unexplained medication discrepancy (95% CI 5.52 to 27.08; p < 0.001). Patients who were first seen by a physician within 1 hour of a change in working shift had 3.70 greater odds of having an unexplained medication discrepancy (95% CI 1.67 to 8.18; p = 0.001). For each additional minute of wait time for a physician, the odds of having an unexplained medication discrepancy increased by a factor of 1.01 (95% CI 1.00 to 1.01; p = 0.042).
CONCLUSIONS: Patient-, environment-, and drug-related factors contribute to the risk of medication discrepancies across transition points from the ED.
Key Words: care transition, communication, emergency department, medication discrepancy, medication reconciliation
Published Online, October 20, 2009. www.theannals.com, DOI 10.1345/aph.1M206
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