Impact of sample size on variation of adverse events and preventable adverse events: systematic review on epidemiology and contributing factors

Lessing, Constanze; Schmitz, Astrid; Albers, Bernhard; Schrappe, Matthias

doi:10.1136/qshc.2008.031435

Cited by 26 publications

(28 citation statements)

References 58 publications

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“…Such estimates vary significantly depending on the context (Lessing et al 2010). Combining an extreme estimate of a 44.1% avoidable death rate (Healey et al 2002) with the estimated one in 55 deaths due to high occupancy in our study results in a combined estimate of 4.2% avoidable deaths due to high occupancy.…”

Section: Effect Size Estimationsmentioning

confidence: 82%

Stress on the Ward: Evidence of Safety Tipping Points in Hospitals

2015

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D o hospitals experience safety tipping points as utilization increases, and if so, what are the implications for hospital operations management? We argue that safety tipping points occur when managerial escalation policies are exhausted and workload variability buffers are depleted. Front-line clinical staff is forced to ration resources and, at the same time, becomes more error prone as a result of elevated stress hormone levels. We confirm the existence of safety tipping points for in-hospital mortality using the discharge records of 82,280 patients across six high-mortality-risk conditions from 256 clinical departments of 83 German hospitals. Focusing on survival during the first seven days following admission, we estimate a mortality tipping point at an occupancy level of 92.5%. Among the 17% of patients in our sample who experienced occupancy above the tipping point during the first seven days of their hospital stay, high occupancy accounted for one in seven deaths. The existence of a safety tipping point has important implications for hospital management. First, flexible capacity expansion is more cost-effective for safety improvement than rigid capacity, because it will only be used when occupancy reaches the tipping point. In the context of our sample, flexible staffing saves more than 40% of the cost of a fully staffed capacity expansion, while achieving the same reduction in mortality. Second, reducing the variability of demand by pooling capacity in hospital clusters can greatly increase safety in a hospital system, because it reduces the likelihood that a patient will experience occupancy levels beyond the tipping point. Pooling the capacity of nearby hospitals in our sample reduces the number of deaths due to high occupancy by 34%.

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Section: Effect Size Estimationsmentioning

confidence: 82%

Stress on the Ward: Evidence of Safety Tipping Points in Hospitals

2015

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“…This factor has been identified in previous reviews as important in affecting event frequency. 54,58 Information on the avoidability of events was also limited and examined on a variety of criteria. This aspect is a source of heterogeneity and probably affected the results, contributing to increased statistical heterogeneity.…”

Section: Discussionmentioning

confidence: 99%

Adverse drug events among adult inpatients: a meta-analysis of observational studies

2014

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SUMMARYWhat is known and objective: Studies in a number of countries have shown that adverse drug events (ADE) occur frequently among hospital inpatients. The objective of this study was to conduct a systematic review of observational studies of the frequency of ADE in adult inpatients and to examine factors associated with observed heterogeneity in the reported results. Methods: The systematic review included observational studies, which identified and analysed ADE during hospitalization of adult inpatients. The literature search was conducted on MED-LINE, Embase, Lilacs and Google Scholar (January of 2000 to June of 2013). Article selection, quality assessment and information extraction were performed by two of the authors, working independently. Using the random-effects model, the proportion of patients with adverse events was used as an outcome measure. Proportion was estimated for subgroups based on event identification method: stimulated reporting (SR), retrospective monitoring (RM) and prospective monitoring (PM). For the latter group, meta-regression was used to identify sources of heterogeneity in the estimates. Results and discussion: Twenty-eight articles from the 7550 identified met our inclusion criteria. The articles were heterogeneous in terms of quality, outcome definition and event identification method and in the corresponding descriptions. Of the 28 articles selected, 25 were included in the corresponding quantitative summary: four used SR, six RM and 15 PM, returning incidences of 2Á3% (CI 95%: 1Á6-4Á5), 8Á7% (CI 95%: 4Á8-15Á3) and 21Á3% (CI 95%: 15Á7-28Á3), respectively, and I 2 greater than 95%. There were other sources of heterogeneity, including the use of combined strategies within each subgroup. In the PM subgroup, using multivariate meta-regression model, no variables were found to associate with proportion. What is new and conclusion: Event frequency seems to associate with the event identification method. PM returned the highest estimates. This subgroup used a greater diversity of approaches for event identification and more diverse data sources. Improved recording of information on the event identification method, the characteristics of the events and the conduct of the study would enable more reliable and precise estimates of the frequency of ADE among hospital inpatients. WHAT IS KNOWN AND OBJECTIVEHospital studies in a number of countries have identified high incidences of drug-related adverse events occurring during hospital stay. The estimates are high and vary widely across studies. In recent years, meta-analyses have been made to summarize the frequency of such events.1,2 Other reviews of the frequency of drug-related events among adult inpatients have either included only the ones identified at admission 3,4 or did not calculate summary measures. 5,6 Systematic reviews aiming to estimate the prevalence or incidence of events are often complicated by heterogeneity of eligible studies. However, the aim of a meta-analysis is not only to compute a summary measure but also to hig...

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“…3 When all health care settings are considered, estimates of the incidence of adverse events range from 0.1% to 65.4%, with little difference between countries, settings, or specialties (23,696,252 patients, 156 studies). 4 A higher incidence is reported among elderly patients. 5 Administration of intravenous medicines is particularly vulnerable to error, with 50% to 70% of doses affected, 6,7 and there are reports of nurses failing to administer medicines.…”

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confidence: 98%

Learning Outcomes Associated With Patient Simulation Method in Pharmacotherapy Education

Aura

Sormunen

Jordan

et al. 2015

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare

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The aims of this systematic integrative review were to identify evidence for the use of patient simulation teaching methods in pharmacotherapy education and to explore related learning outcomes. A systematic literature search was conducted using 6 databases as follows: CINAHL, PubMed, SCOPUS, ERIC, MEDIC, and the Cochrane Library, using the key words relating to patient simulation and pharmacotherapy. The methodological quality of each study was evaluated. Eighteen articles met the inclusion criteria. The earliest article was published in 2005. The selected research articles were subjected to qualitative content analysis. Patient simulation has been used in pharmacotherapy education for preregistration nursing, dental, medical, and pharmacy students and for the continuing education of nurses. Learning outcomes reported were summarized as follows: (1) commitment to pharmacotherapy learning, (2) development of pharmacotherapy evaluation skills, (3) improvement in pharmacotherapy application skills, and (4) knowledge and understanding of pharmacotherapy. To develop effective teaching methods and ensure health care professionals' competence in medication management, further research is needed to determine the educational and clinical effectiveness of simulation teaching methods.

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Impact of sample size on variation of adverse events and preventable adverse events: systematic review on epidemiology and contributing factors

Cited by 26 publications

References 58 publications

Stress on the Ward: Evidence of Safety Tipping Points in Hospitals

Stress on the Ward: Evidence of Safety Tipping Points in Hospitals

Adverse drug events among adult inpatients: a meta-analysis of observational studies

Learning Outcomes Associated With Patient Simulation Method in Pharmacotherapy Education

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