“That really shouldn't have happened”: People with aphasia and their spouses narrate adverse events in hospital

Abstract

Background: Patients with communication disability are at increased risk of experiencing an adverse event in hospital. Despite forming a particularly vulnerable patient group, little is known about the nature or cause of adverse events experienced by people with aphasia and their spouses in hospital.

Aims: This study aimed to: (a) describe the adverse events experienced by people with aphasia and their spouses in hospital, (b) identify the situations, people, events, and outcomes relevant to the adverse events, and (c) identify commonalities in participant stories of adverse events.

Methods & Procedures: In this narrative inquiry, ten people with chronic aphasia and their spouses participated in in-depth interviews about the adverse events they experienced or witnessed in hospital. A narrative analysis was used to discover common stories of adverse events and common content themes across the stories of experience.

Outcomes & Results: Although a wide variety of adverse event types were identified in the participants' stories, “undesirable events” were among the most common, along with “inappropriate discharge home or inadequate discharge plan”. Reliance upon spouses during communicative interactions featured across the stories, with exclusion of spouses from important interactions on the ward representing a barrier to effective communication and a risk for adverse events. Participants suggested strategies for improving the safety of people with aphasia in hospital in the hope of preventing future adverse events in this population.

Conclusions: Adverse events occurring in hospital were distressing to participants and often related to the presence of aphasia. Hospital policies should acknowledge the role that spouses have with patients with aphasia and ensure their inclusion to assist in prevention and management of adverse events in hospitalised patients with aphasia. The need for better discharge planning and information should also be recognised as a means of preventing adverse events.

Keywords:

• Aphasia
• Communication disorders
• Adverse events

Acknowledgments

We wish to acknowledge the assistance of Sarah Wallace with final editing. Many thanks also to the UQ Aphasia Registry and the participants in this study. The first author is supported in part by a National Health and Medical Research Council of Australia Postdoctoral Fellowship.

Notes

*Includes any unexpected complication occurring during the admission that is not a natural progression of the patient's disease or an expected outcome of treatment.

^†Includes neurological deficits related to procedures, treatments or investigations.

^‡Excludes infections or sepsis occurring less than 72 hours after admission.