The incidence and nature of adverse events in rehabilitation inpatients with acquired brain injuries.

BACKGROUND: Patient safety is important in all healthcare settings. Few studies have examined the state of patient safety in rehabilitation and none have examined patient safety in the setting of acquired brain injury (ABI) rehabilitation. OBJECTIVES: To determine the incidence, most common types, and severities of adverse events among inpatients undergoing ABI rehabilitation. DESIGN: Retrospective case series descriptive study. SETTING: The inpatient ABI rehabilitation program at an academic, tertiary rehabilitation hospital in Canada. PARTICIPANTS: One hundred eight consecutive inpatients with acquired brain injuries. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patient charts and incident reports from the hospital's voluntary reporting system were reviewed by three board-certified physiatrists to determine the incidence, type, severity and preventability of adverse events. Adverse events were identified and classified for severity and type using the World Health Organization (WHO) International Classification for Patient Safety. Preventability was rated on a six-point Likert scale. RESULTS: During the study period, the incidence of adverse events was 17.42 ± 3.86 per 1000 patient days. Adverse events affected 52.8% of patients. Most adverse events identified were mild in severity (81.6%) and the rest were of moderate severity. The two most common types of adverse events were (1) patient incidents (50%) such as falls, pressure ulcers and skin tears and (2) patient behaviors such as missing patient, assault, or sexual behaviors (14.5%). Of the 76 adverse events identified in the study, 44.8% were preventable. The hospital's voluntary reporting system did not capture 57.9% of the adverse events identified. CONCLUSIONS: Future efforts to improve patient safety in ABI rehabilitation should focus on reducing falls, skin injuries and behaviors, and removing barriers to voluntary incident reporting. Detection of adverse events through chart reviews provides a more complete understanding of patient safety risks in ABI rehab than relying on incident reporting alone.

Polyarticular Neurogenic Heterotopic Ossification in a Spinal Cord Injury: A Case Report from Saudi Arabia.

A 33-year-old male victim of a motor vehicle accident, who presented with a T12 (thoracic 12 vertebra) burst fracture (ISNCSCI T11 AIS-A: International Standards for Neurological Classification of Spinal Cord Injury T11 ASIA Impairment Scale), was admitted to a rehabilitation hospital. A stage-II left ischial pressure ulcer was also reported. An X-ray of the pelvis revealed bilateral neurogenic heterotopic ossification (NHO) in both hips and knees, which was further confirmed by TC-99m methylene diphosphonate (MDP) bone scintigraphy. Interventions included indomethacin and conservative management. Surgery was not preferred, as NHO was still immature. Moreover, patient transfer and lower body dressing were unaffected by NHO. It is important to consider an early radiological screen in selected high-risk cases for NHO, to minimize the risk of associated complications.