Connecting perspectives on quality and safety: patient-level linkage of incident, adverse event and complaint data.

BACKGROUND AND OBJECTIVE: Incident, adverse event (AE) and complaint data are typically used separately, but may be related at the patient level with one event triggering a cascade of events, ultimately resulting in a complaint. This study examined relations between incidents, AEs and complaints that co-occurred in admissions. METHODS: Independently and routinely collected incident, AE and complaint data were retrospectively linked for surgical admissions in an academic centre (2008-2014). Two investigators reviewed whether incidents/AEs in admissions were clinically related and in what sequence (incident preceding vs following AE). Likelihood of occurrence of AEs and AE cascades (ie, ≥3 AEs) was studied using logistic regression analyses. RESULTS: Complaints were filed for 33 (0.1%) of 26 383 admissions. Complaints filed by patients with incidents and/or AEs (n=13) mostly addressed quality/safety problems, whereas other complaints mostly addressed relationship problems. Incidents and AEs co-occurred in 730 (2.8%) admissions, which seemed clinically related in 34% of these cases. Incidents with related AEs preceded as well as followed AEs (56.6%/44.4%). Patients with incidents were at greater risk of AEs than patients without incidents, even for seemingly unrelated AEs (OR 1.4; 95% CI 1.3 to 1.6). Risk of AE cascades was greater when patients with AEs also had incidents, regardless of whether these seemed related (unrelated: OR 2.0; 95% CI 1.6 to 2.5; related: OR 5.7; 95% CI 4.3 to 7.4) or whether incidents preceded or followed AEs in these admissions (53% vs 52%, P>0.05). CONCLUSIONS: Patient-level linkage of incident, AE and complaint data can reveal relations between events that otherwise remain obscured, such as incidents that trigger as well as follow AEs, introducing event cascades, regardless of whether clinical relations seem present.

[Malnutrition in patients with cancer]. / Ondervoeding bij patiënten met kanker.

Malnutrition is a condition characterized by a shortage or imbalance of energy and proteins and/or other nutrients. Malnutrition leads to measurable undesirable effects on body size and composition, functioning and clinical results. Criteria for malnutrition are eight loss, low BMI and loss of muscle mass. Patients with cancer should be repeatedly screened for malnutrition and its risk factors during the diagnostic and therapeutic treatment trajectory. Patients with cancer who are malnourished or are at risk of becoming so should be referred to a dietician for individualized dietary advice if they are undergoing curative treatment or before they do so. At the start of radiotherapy and/or chemotherapy treatment, tube feeding or parenteral feeding is given to all cancer patients who are malnourished or are at high risk of becoming malnourished. If the gastrointestinal tract is functioning well then tube feeding is preferable to parenteral feeding. Patients who are at an advanced stage of cancer and cancer patients who are anorexic or lose weight can be treated with megastrol acetate.