Emergency re‐admissions to hospital due to adverse drug reactions within 1 year of the index admission

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Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT ADRs in hospital patients are a significant burden, though how often ADRs cause re‐admission to hospital has not been well documented in the literature. WHAT THIS STUDY ADDS • One fifth of patients re‐admitted to hospital within 1 year of discharge from their index admission were re‐admitted due to an adverse drug reaction.• Admission to a medical ward, elderly age and prescription of anti‐platelet agents or diuretics were identified as risk factors for re‐admission due to ADRs.• Since up to 50% of these reactions were possibly avoidable, better methods of medication review in both hospital and primary care, in conjunction with a clinical review, are needed to enable improved prescribing practices that will be essential for improving the benefit‐harm balance of medicines.AIM: The proportion of re‐admissions to hospital caused by ADRs is poorly documented in the UK. The aim of this study was to evaluate the impact of ADRs on re‐admission to hospital after a period as an inpatient.METHODS: One thousand patients consecutively admitted to 12 wards were included. All subsequent admissions for this cohort within 1 year of discharge from the index admission were retrospectively reviewed.RESULTS: Of the 1000 patients included, 403 (40.3%, 95% CI 39.1, 45.4%) were re‐admitted within 1 year. Complete data were available for 290 (70.2%) re‐admitted patients, with an ADR contributing to admission in 60 (20.8%, 95% CI 16.4, 25.6%) patients. Presence of an ADR in the index admission did not predict for an ADR‐related re‐admission (10.5% vs. 7.2%, P = 0.25), or re‐admission overall (47.2% vs. 41.2%, P = 0.15). The implicated drug was commenced in the index admission in 33/148 (22.3%) instances, with 37/148 (25%) commenced elsewhere since the index admission. Increasing age and an index admission in a medical ward were associated with a higher incidence of re‐admission ADR. The most frequent causative drugs were anti‐platelets and loop diuretics, with bleeding and renal impairment the most frequent ADRs. Over half (52/91, 57.1%) of the ADRs were judged to be definitely or possibly avoidable.CONCLUSIONS: One fifth of patients re‐admitted to hospital within 1 year of discharge from their index admission are re‐admitted due to an ADR. Our data highlight drug and patient groups where interventions are needed to reduce the incidence of ADRs leading to re‐admission.

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