Comparison of three methods for estimating rates of adverse events and rates of preventable adverse events in acute care hospitals

Abstract

Objectives To compare the effectiveness, reliability, and acceptability of estimating rates of adverse events and rates of preventable adverse events using three methods: cross sectional (data gathered in one day), prospective (data gathered during hospital stay), and retrospective (review of medical records). Design Independent assessment of three methods applied to one sample. Setting 37 wards in seven hospitals (three public, four private) in southwestern France. Participants 778 patients: medical (n = 278), surgical (n = 263), and obstetric (n = 237). Main outcome measuresThe main outcome measures were the proportion of cases (patients with at least one adverse event) identified by each method compared with a reference list of cases confirmed by ward staff and the proportion of preventable cases (patients with at least one preventable adverse event). Secondary outcome measures were inter-rater reliability of screening and identification, perceived workload, and face validity of results. Results The prospective and retrospective methods identified similar numbers of medical and surgical cases (70% and 66% of the total, respectively) but the prospective method identified more preventable cases (64% and 40%, respectively), had good reliability for identification ( = 0.83), represented an acceptable workload, and had higher face validity. The cross sectional method showed a large number of false positives and identified none of the most serious adverse events. None of the methods was appropriate for obstetrics. Conclusion The prospective method of data collection may be more appropriate for epidemiological studies that aim to convince clinical teams that their errors contribute significantly to adverse events, to study organisational and human factors, and to assess the impact of risk reduction programmes.

Proposta de um instrumento para avaliar eventos adversos em odontologia

“…The methodology was later replicated in other studies 14,40,41,42 and acknowledged as an important approach to document and assist the identification of patient harm.…”

Impact of Morbidity and Mortality Conferences on Analysis of Mortality and Critical Events in Intensive Care Practice

“…[1][2][3][4] Reviews of hospital charts from the 1990s to 2009 have revealed that adverse events, defined as unintended injuries or complications that are provoked by medical management rather than the patient's underlying disease, occurred in 2.9% to 16.6% of hospitalized patients. [5][6][7][8][9] Moreover, in those retrospective studies, 20% to 57% of the adverse events were judged potentially preventable. 5,[9][10][11] However, agreement between chart reviewers in assessing preventability or contribution of care management to adverse events has remained poor, and preventable adverse events were more common in elderly and severely ill patients, suggesting that both preventable adverse events and in-hospital deaths are not systematically associated with medical errors.…”

“…[5][6][7][8][9] Moreover, in those retrospective studies, 20% to 57% of the adverse events were judged potentially preventable. 5,[9][10][11] However, agreement between chart reviewers in assessing preventability or contribution of care management to adverse events has remained poor, and preventable adverse events were more common in elderly and severely ill patients, suggesting that both preventable adverse events and in-hospital deaths are not systematically associated with medical errors. 3,5,8,[10][11][12][13] Indeed, 90% of preventable deaths seem to result from failures in the system of care organization or procedures, but not from caregivers' negligence.…”

Application of a Complication Screening Method to Congenital Heart Surgery Admissions

“…Since the Institutes of Medicine reported that patient safety events are frequent and are associated with death, there has been an increased effort to identify these unwanted patient events [1,6,16,19,20,24]. At present, there is no completely accurate method of capturing all patient safety events in all situations.…”