Epidemiological factors associated with safety incidents due to patient Behavior reported in the hospital setting

Abstract

Background: Incident reporting systems are an essential element in hospital safety programs. Our objective was to describe the magnitude, evolution and characteristics of adverse events due to patient behavior reported in a high complexity reference university hospital.

Methods: Cross-sectional study. Period 2016-2019. From the hospital registry of adverse events, the notifications of the taxonomy “Patient behavior” were obtained. They were classified according to: type of behavior, category of the reporting professional, care area, sex of the patient/companion, risk and year. The χ² test for the comparison of qualitative variables was used, and using a generalized linear model with Poisson distribution, prevalence ratio (PR) and 95% confidence intervals (95%CI) were estimated.

Results: Patient behavior reported incidents represented the 8.2%. There was an increasing trend with a slight decrease in the last year (2016 12.4%; 2017 29.5%; 2018 32.5% and 2019 25.6%). The areas of neurological and psychiatric diseases, and emergencies reported 36.9% and 19.7% of the cases, respectively. Nursing was the most reporting group (73.2%). More than 60% of notifications involved male patients. The PR doubled in escapes or attempts (2.2; 95% CI=1.4-3.5), tripling in non-compliance with hospital rules (3.0; 95% CI=1.9-4.7) and aggressive or intimidating behaviors (3.4: 95% CI=2.2-5.3).

Conclusions: An increase in notifications related to patient behaviors is observed, with a slight decrease in the last year. This study objectively shows and characterizes a problem that is now especially relevant due to the influence of the COVID-19 pandemic on mental health, which quality and clinical safety programs must consider to minimize the associated risks.

Key words: Patient safety; Risk management; Problem behavior; Mental Health; Hospital.