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Cost of Poor Quality or Waste in Integrated Delivery System Settings

Table 3: Total Incremental Cost and Patient Days Associated with Voluntary Event Reports

Event Type Cost per Event Number of Events Total Cost Days per Event Total Days
Medication $913 4543 $4,149,346 0.52 2364
Treatment $501 4622 $2,316,702 0.25 701
Fall $897 1025 $919,507 0.68 1162
Equipment $489 635 $310,808 0.25 124
Behavioral $659 569 $375,126 0.20 238
Loss/Exposure $552 542 $299,448 0.42 265
Overall $749 11936 $8,370,937 0.43 4854

Notes: Total cost and days for each event report type of is calculated by multiplying the type-specific per event estimate by the number events of that type. The total cost and days reported above is the sum of the type-specific total cost and days to reflect the frequency of each event type. The overall cost and days per event estimate reported above in italics is from the initial regressions that did not contain type dummy variables and is not used in the calculation of total cost and days.

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Table 4: Distribution of Medication Event Subtypes

Medication Subtype Percent of Medication Events Percent with No Harm
Omission 30% 95%
Other 14% 86%
Wrong Dose 11% 95%
Wrong Time 9% 99%
Wrong Drug 7% 97%
Infiltration/Phlebitis 6% 35%
Incomplete Documentation 6% 98%
Wrong Rate 5% 94%
Wrong Patient 3% 99%
Narcotic Count Related 2% 99%
Wrong Solution 2% 96%
Wrong Route 2% 93%
Wasted Blood/Blood Products 1% 91%
Wrong Preparation 1% 90%
Adverse Reaction 1% 49%
Contra Indication 1% 91%

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Table 5: Distribution of Fall Event Subtypes

Fall Subtype Percent of Fall Events Percent with No Harm
From Bed 35% 82%
From Walk/Stand 34% 81%
From Commode/Toilet 10% 78%
From Chair/Stool 8% 89%
Other 6% 75%
Visitor Fall 3% 79%
In Hallway 1% 82%
From Wheelchair 1% 100%
From Table/Stretcher 1% 57%
From Shower/Tub 0% 80%

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Table 6: Distribution of Treatment Event Subtypes

Treatment Subtype Percent of Treatment Events Percent with No Harm
Delayed 27% 94%
Omitted 26% 94%
Incorrect 15% 92%
Other 14% 90%
Procedural Complication 3% 52%
Wrong Patient 3% 89%
Count Discrepancy 3% 99%
Skin Issue 2% 51%
H&P Issue 1% 100%
Contamination 1% 92%
Unattended Delivery 1% 95%
Wrong Time 1% 96%
Injury 0% 65%
Test Discrepancy 0% 100%
Unexpected Death 0% 50%
Latex Sensitivity 0% 83%
Wrong Site 0% 100%

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Table 7: Distribution of Equipment Event Subtypes

Equipment Subtype Percent of Equipment Events Percent with No Harm
Malfunction 49% 91%
Other 19% 89%
Not Available 16% 88%
SMDA Related 8% 86%
Incorrect 6% 97%
Improper Disposal 3% 95%

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Table 8: Distribution of Behavioral Event Subtypes

Behavioral Subtype Percent of Behavioral Events Percent with No Harm
Complaint 35% 91%
Other 26% 94%
Verbal Abuse 9% 98%
Physical Abuse/Threat 8% 77%
Unable to Contact Physician 6% 97%
Elopement 4% 100%
Self Inflicted Injury 4% 50%
AMA 4% 100%
Suicide Attempt 2% 73%
Legal Action/Threat of Action 1% 100%
Trespassing 1% 100%
Contraband 1% 100%
Illegal Drugs/Weapons 0% 100%
Sexual Abuse 0% 100%

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Table 9: Distribution of Loss Event Subtypes

Loss Subtype Percent of Loss Events Percent with No Harm
Lost/Damaged/Stolen 41% 98%
Other 35% 92%
Exposure 13% 90%
Environmental 10% 96%
Signage Not Used 0% 100%

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Proceed to Appendix C

 

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