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PHILIP E. JOHNSTON, PHARM.D., is Assistant Director, Department of Pharmaceutical Services, Vanderbilt University Medical Center (VUMC), Nashville, TN. DANIEL J. FRANCE, PH.D., M.P.H., is Research Assistant Professor of Medicine and Anesthesiology, School of Medicine, Vanderbilt University (VU), Nashville, and Improvement Consultant, Center for Clinical Improvement, VUMC. DANIEL W. BYRNE, M.S., is Director, Biostatistics and Study Design, Department of Biostatistics, General Clinical Research Center, VUMC. HARVEY J. MURFF, M.D., M.P.H., is Assistant Professor of Medicine, School of Medicine, VU, and Assistant Professor of Medicine, Department of Veterans Affairs, Tennessee Valley Geriatric Research Education Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville. BYRON LEE, M.B.A., is Database Analyst, Center for Clinical Improvement, VUMC. RENEE A. STILES, PH.D., is Assistant Professor, Medicine and Nursing; and THEODORE SPEROFF, PH.D. is Research Associate Professor of Medicine, School of Medicine, VU.

Address correspondence to Dr. Johnston at the Department of Pharmaceutical Services, Vanderbilt University Medical Center, B-101 VUH, 1161 21st Avenue South, Nashville, TN 37232-7610 (phil.johnston{at}vanderbilt.edu).

Purpose. Specific patient and clinical characteristics associated with an increased risk of sustaining an adverse event (AE) were identified. Methods. AE reports for patients in a 658-bed tertiary care medical center between January 1, 2000, and June 30, 2002, were analyzed. The data collected from each report included medical record number, patient sex, patient age, clinical service, date of occurrence, diagnoses, type of error, suspected medication, and severity of the AE. A three-stage logistic regression model with high-risk indicators was used to evaluate key indicators of the most vulnerable patient populations. Results. The number of control patients and those with AEs totaled 60,206. This population was then randomly split into two equal groups of patients: the training data set (n = 30,103) and the validation data set (n = 30,103). AEs occurred in a higher percentage of patients who were age <1 year, 1–15, 47–59, and 60 years than in other groups. A higher percentage of AEs were reported in men than women, but the groups were not significantly different when comparing those with an AE and those without an AE. Asian Indian patients demonstrated a high rate of AEs, but this may be a statistical artifact, reflecting their very small percentage in the study. Evaluation of admission sources revealed that doctors’ offices, clinic referrals, and local hospital transfers accounted for higher rates of AEs than other sources. Conclusion. Certain age groups, diagnoses, admission sources, types of insurance, and the use of specific medications or medication classes were associated with increased AE rates at a tertiary care medical center. Index terms: Age; Errors, medication; Health-benefit programs; Hospitals; Quality assurance; Race; Risk management; Sex; Toxicity