The occurrence, types, consequences and preventability of in-hospital adverse events – a scoping review

Abstract

BackgroundAdverse events (AEs) seriously affect patient safety and quality of care, and remain a pressing global issue.This study had three objectives: (1) to describe the proportions of patients affected by in-hospital AEs; (2) to explore the types and consequences of observed AEs; and (3) to estimate the preventability of in-hospital AEs.MethodsWe applied a scoping review method and concluded a comprehensive literature search in PubMed and CINAHL in May 2017 and in February 2018. Our target was retrospective medical record review studies applying the Harvard method–or similar methods using screening criteria–conducted in acute care hospital settings on adult patients (≥18 years).ResultsWe included a total of 25 studies conducted in 27 countries across six continents. Overall, a median of 10% patients were affected by at least one AE (range: 2.9–21.9%), with a median of 7.3% (range: 0.6–30%) of AEs being fatal. Between 34.3 and 83% of AEs were considered preventable (median: 51.2%). The three most common types of AEs reported in the included studies were operative/surgical related, medication or drug/fluid related, and healthcare-associated infections.ConclusionsEvidence regarding the occurrence of AEs confirms earlier estimates that a tenth of inpatient stays include adverse events, half of which are preventable. However, the incidence of in-hospital AEs varied considerably across studies, indicating methodological and contextual variations regarding this type of retrospective chart review across health care systems. For the future, automated methods for identifying AE using electronic health records have the potential to overcome various methodological issues and biases related to retrospective medical record review studies and to provide accurate data on their occurrence.

Adverse events in Malaysia: Associations with nurse's ethnicity and experience, hospital size, accreditation, and teaching status

“…A review of 25 studies in 27 countries revealed that 10.0% of all in‐patients suffered from an adverse event and over 80.0% of these adverse events were preventable . Further, it is estimated that 142,000 patients died from medical treatment adverse effects globally .…”

A Network Analysis of Perioperative Communication Patterns

“…Authors of another study reviewed eight studies conducted between 1991 and 2006 and found that more adverse events occur in the OR (41.0%) than in other complex work settings, such as the intensive care unit (3.1%) and the emergency department (3.0%) . A review of 25 studies investigating the incidence of adverse events between 1991 and 2017 in 27 countries showed that 51.2% (range, 34.3% to 83%) were preventable . Although the incidence of reported surgical adverse events may vary, a 2018 study at a Level 1 trauma center in Amsterdam showed that “146 [(99.3%)] out of 147 adverse events were not described in the operation report.” (p461)…”

Increased reporting but decreased mortality associated with adverse events in patients undergoing lung cancer surgery: Competing forces in an era of heightened focus on care quality?

“…What factors would result in a possible behavioral shift in event coding practice? The "culture of quality" in healthcare, designed to improve team function, patient centeredness, transparency, and outcomes, stresses the importance of detailed and complete documentation [14,15,48,49]. Alternatively, widespread implementation of the electronic health record may have simplified the process of selecting and recording diagnostic codes [50].…”

“…Indeed, tracking complications of medical treatment is no longer relegated to the domain of research studies, but is incorporated into real-time evaluation of care [11,12]. Accompanying this trend has been progress towards standardization of event tracking, with financial and clinical measures broadly applied across hospitalizations and institutions, regardless of admitting diagnosis or inpatient procedures [13][14][15].…”