A study analyzes the occurrence of serious adverse events (SAEs) during the hospitalization of psychiatric patients. In total, 144 SAEs (6.4%) were recorded, including 137 urgent transfers and 7 deaths. Life-threatening emergencies represented 51% of SAEs, mainly due to respiratory distress. Iatrogenics was suspected in 41% of cases and an infectious cause in 38%.. The period of the first 48 hours of hospitalization is particularly at risk.
People with psychiatric disorders have higher mortality than the general population, particularly in relation to cardiovascular risk factors, psychotropic medications and limited access to care. This finding suggests a greater incident rate in psychiatric hospitalization.
The main objective of this study is to describe the occurrence of serious adverse events (SAEs) during psychiatric hospitalization, defined here by unexpected deaths occurring during hospitalization and unscheduled transfers to general emergency departments. It was carried out over a period of 24 months, to analyze SAEs among adults hospitalized in psychiatric establishments. Demographic characteristics, comorbidities, reasons for emergency use and diagnoses, iatrogenicity, mortality at one and six months from the occurrence of SAE were listed.
Results
In 2022 and 2023, out of 2,255 full-time hospitalization admissions, 144 SAEs were recorded, representing 6.4% of admissions. Of these, 137 were emergency department transfers (95%) and 7 were unexpected deaths (5%), representing an unexpected mortality rate of 3 per 1,000 admissions..
Infections represented 38% of SAEs (55 cases out of 144), and 36% (52 cases out of 144) were healthcare-associated infections (HAIs).). Concerning all cases of infection, half were pulmonary (29 cases out of 55, 53%), followed by urinary infections (9 cases out of 55, 16%), digestive (8 cases out of 55, 15%) and skin and soft tissues (8 cases out of 55, 13%).
The time to occurrence of an SAE was less than 48 hours in 20% of cases, highlighting a high-risk period at the start of hospitalization.
Life-threatening emergencies constituted 51% of SAEs (73 cases out of 144), mainly due to respiratory failure (47%, 34 cases out of 73), neurological (19%, 14 cases out of 73) and multivisceral (14%, 10 cases out of 73). An infectious cause was found in 42% (31 cases out of 73) of life-threatening emergencies.
Transfers without a life-threatening emergency (71 cases out of 144) were mainly motivated by infectious (34%, 24 cases out of 71) and traumatic (24%, 17 cases out of 71) causes. Mortality was 10% (15 cases out of 144) at one month and reached 16% (23 cases out of 144) at six months after the occurrence of the SAE. In univariate analysis, deaths at one month following SAE were significantly associated with alcohol use disorders (p=0.003) and life-threatening emergencies on admission (p=0.001)
Among SAEs with suspected or probable iatrogenicity, a third of cases corresponded to vigilance disorders associated with lower respiratory infections (aspiration pneumonia) and a third to isolated vigilance disorders, all attributable to the use – alone or in combination – of benzodiazepines. (tableau 2).
Generally speaking, for the authors, the occurrence of these SAEs should lead to questioning the organization of care. The EPSM studied is located 40 minutes from the first emergency reception service. While according to the Drees, 67% of establishments providing psychiatric care are monodisciplinary, it may seem relevant to develop training for life-threatening emergencies.
This work advocates the promotion of reinforced surveillance during the first 48 hours of admission, as well as the improvement of the prevention of iatrogenics.. These actions are essential to strengthen patient safety and reduce intrahospital morbidity and mortality. A prospective multicenter study and systematic monitoring of SAEs defined by transfer to the emergency room and unexpected deaths within EPSMs would make it possible to specify the measures necessary for the prevention of hospital morbidity and mortality.
Analysis of serious adverse events in patients hospitalized in psychiatry: retrospective descriptive study, BEH 16, July 7, 2026, Elena Rentea 1,2 (elena.rentea@chu-nimes.fr), Sylvie Louvard 3Pierre-Marie Roger 4Patricia Étienne
1 Le Mas Careiron Hospital Center, Uzès
2 Regional Federation for Research in Psychiatry and Mental Health of Occitanie (Ferrepsy), Saint-André-lez-Lille
3 Samu Smur emergency department, Nîmes University Hospital
4 Infectious disease department, Les Fleurs polyclinic, Ollioules
