What are the risks associated with being admitted to a hospital?

Risks of Hospital Admission

Being admitted to a hospital carries substantial risks, with adverse events occurring in approximately 1 in 4 admissions (23.6%), of which nearly one-quarter are preventable, including medication errors, surgical complications, healthcare-associated infections, and patient-care events like falls. 1

Major Categories of Hospital-Related Harm

Adverse Events During Hospitalization

• Adverse drug events are the most common type of harm, accounting for 39% of all adverse events during hospitalization 1
• Surgical or procedural complications represent 30.4% of adverse events 1
• Patient-care events (including falls and pressure ulcers) account for 15% of adverse events 1
• Healthcare-associated infections comprise 11.9% of adverse events 1

Severity and Preventability

• Among all adverse events identified, 32.3% are classified as serious or higher severity, meaning they cause substantial harm requiring significant intervention or prolonged recovery 1
• Preventable adverse events occur in 6.8% of all hospital admissions, with 1% experiencing preventable events of serious severity or higher 1
• Deaths occur in a small proportion of cases, with approximately one in seven deaths deemed preventable 1

Specific High-Risk Scenarios

Inappropriate Hospital Admissions

• Patients with inappropriate hospital admissions have a 3.5-fold increased risk of developing subsequent adverse events compared to those with appropriate admissions 2
• Inappropriate admissions double the mean number of adverse events per patient 2
• These adverse events are predominantly associated with scheduled (non-emergency) admissions, occurring in 78.9% of cases following inappropriate admission versus 27.9% after appropriate admissions 2
• Adverse events following inappropriate admissions add an average of 2.4 additional days in the intensive care unit 2

Medication-Related Risks

• Community-acquired adverse drug reactions are present in 8.5% of hospital admissions, with 3.8% of admissions occurring directly because of these reactions 3
• Physicians fail to recognize 56.9% of adverse drug reactions present at the time of admission 3
• 18.6% of all medications prescribed prior to hospital admission are contraindicated, with diuretics, NSAIDs/analgesics, and antipsychotics/sedatives being the most problematic 3

Population-Specific Risks

Patients with Diabetes

• Hospital readmission rates for patients with diabetes are 14-20%, nearly twice the rate of patients without diabetes 4
• Among hospitalized patients with diabetes, hyperglycemia, hypoglycemia, and glucose variability are associated with increased morbidity and mortality 4
• 30% of patients with diabetes who are hospitalized have two or more hospital stays, accounting for over 50% of inpatient costs 4

Older Adults

• Insulin-treated patients 80 years or older are more than twice as likely to visit the emergency department and nearly five times as likely to be admitted for insulin-related hypoglycemia compared to those aged 45-64 years 4
• Elderly patients with thrombocytopenia may require more aggressive management due to higher bleeding risk 5, 6

Severe Community-Acquired Pneumonia

• Delayed ICU admission significantly increases mortality risk: patients admitted to ICU within 2 days of hospital admission have 46.3% mortality, rising to 50.4% for those admitted between 2-7 days, and 57.6% for those admitted after 7 days 4
• Delayed oxygenation assessment (>3 hours) is an independent risk factor for death with a hazard ratio of 2.06 4

Key Risk Factors for Readmission

The following factors increase the risk of hospital readmission 4:

• Male sex
• Longer duration of prior hospitalization
• Number of previous hospitalizations
• Number and severity of comorbidities
• Lower socioeconomic and/or educational status

Protective factors that reduce readmission rates include scheduled home health visits and timely ambulatory follow-up care 4.

Critical Pitfalls to Avoid

• Failure to ensure proper medication reconciliation at admission, as nearly one-fifth of pre-admission medications may be contraindicated 3
• Inadequate recognition of existing adverse drug reactions at the time of admission, which are missed in more than half of cases 3
• Admitting patients inappropriately, which substantially increases their risk of harm during hospitalization 2
• Delayed assessment and intervention in critically ill patients, particularly regarding oxygenation and ICU admission timing 4
• Poor discharge planning and follow-up coordination, which significantly increases readmission risk 4