The incidence and cost of adverse events in Victorian hospitals 2003–04

Abstract

Objectives: To determine the incidence of adverse events in patients admitted in the year 2003–04 to selected Victorian hospitals; to identify the main hospital‐acquired diagnoses; and to estimate the cost of these complications to the Victorian and Australian health system. Design: The patient‐level costing dataset for major Victorian public hospitals, 1 July 2003 – 30 June 2004, was analysed for adverse events by identifying C‐prefixed diagnosis codes denoting complications, preventable or otherwise, arising during the course of hospital treatment. The in‐hospital cost of adverse events was estimated using linear regression modelling, adjusting for age and comorbidity. Main outcome measures: Cost of each patient admission (“admitted episode”), length of stay and mortality. Results: During the designated timeframe, 979 834 admitted episodes were in the sample, of which 67 435 (6.88%) had at least one adverse event. Patients with adverse events stayed about 10 days longer and had over seven times the risk of in‐hospital death than those without complications. After adjusting for age and comorbidity, the presence of an adverse event adds $6826 to the cost of each admitted episode. The total cost of adverse events in this dataset in 2003–04 was $460.311 million, representing 15.7% of the total expenditure on direct hospital costs, or an additional 18.6% of the total inpatient hospital budget. Conclusion: Adverse events are associated with significant costs. Administrative datasets are a cost‐effective source of information that can be used for a range of clinical governance activities to prevent adverse events.

The incidence and nature of in-hospital adverse events: a systematic review

“…The three studies we excluded because of an insufficient number of patient records evaluated, when combined, 1607 records, amounting to 2% of all records included in this systematic review (more than 74 000 records). The two excluded studies that used a computer-assisted approach7 8 reported incidences of adverse events that were slightly lower (8.3% and 6.9%) than the median incidence of the studies included in the present review. This approach is much less time-consuming than the retrospective record review, but a drawback is that it cannot make judgements on causation or preventability.…”

“…Of the remaining 29 studies, another 17 were excluded after reviewing the full article. Three of these studies applied a different definition of an AE; one study used an observational approach and recorded only errors without linking them to outcomes;6 the other two studies used a computer-assisted approach to screen a large number of patient records for certain codes denoting complications 7 8. Three studies were excluded because of an insufficient number of patient records; one of these studies used retrospective record review;9 the other studies would otherwise have been excluded due to methodological designs that differed from the large record review studies 10 11.…”

Patient safety culture: factors that influence clinician involvement in patient safety behaviours

“…Adverse events are estimated to cost the Australian healthcare system $2 billion per annum3 in direct costs alone.…”

Deriving literature-based benchmarks for surgical complications in high-income countries: a protocol for a systematic review and meta-analysis

“…Mary E Brindle, 1 Derek J Roberts, 2 Oluwatomilayo Daodu, 1 Alex Bernard Haynes, 3,4 Christy Cauley, 3 Elijah Dixon, 5 Claude La Flamme, 6 Paul Bain, 7 Strengths and limitations of this study ► The aims and objectives of the study have been established by a group of international stakeholders in surgical quality and safety representing relevant surgical specialties. ► Results of this meta-analysis need to be interpreted alongside that of landmark trials.…”

“…Despite the fact that the data have not been thoroughly explored, USA, the UK, Canada, Australia and New Zealand have all identified high rates of medical errors contributing to patient deaths and morbidity. [3][4][5][6][7] Surgery plays a central role in the national burden of medical care-related morbidity. 8 This is because surgery is a resource-intensive, often high-risk therapy within which there is ample opportunity for error.…”