To what extent are adverse events found in patient records reported by patients and healthcare professionals via complaints, claims and incident reports?

Abstract

BackgroundPatient record review is believed to be the most useful method for estimating the rate of adverse events among hospitalised patients. However, the method has some practical and financial disadvantages. Some of these disadvantages might be overcome by using existing reporting systems in which patient safety issues are already reported, such as incidents reported by healthcare professionals and complaints and medico-legal claims filled by patients or their relatives. The aim of the study is to examine to what extent the hospital reporting systems cover the adverse events identified by patient record review.MethodsWe conducted a retrospective study using a database from a record review study of 5375 patient records in 14 hospitals in the Netherlands. Trained nurses and physicians using a method based on the protocol of The Harvard Medical Practice Study previously reviewed the records. Four reporting systems were linked with the database of reviewed records: 1) informal and 2) formal complaints by patients/relatives, 3) medico-legal claims by patients/relatives and 4) incident reports by healthcare professionals. For each adverse event identified in patient records the equivalent was sought in these reporting systems by comparing dates and descriptions of the events. The study focussed on the number of adverse event matches, overlap of adverse events detected by different sources, preventability and severity of consequences of reported and non-reported events and sensitivity and specificity of reports.ResultsIn the sample of 5375 patient records, 498 adverse events were identified. Only 18 of the 498 (3.6%) adverse events identified by record review were found in one or more of the four reporting systems. There was some overlap: one adverse event had an equivalent in both a complaint and incident report and in three cases a patient/relative used two or three systems to complain about an adverse event. Healthcare professionals reported relatively more preventable adverse events than patients.Reports are not sensitive for adverse events nor do reports have a positive predictive value.ConclusionsIn order to detect the same adverse events as identified by patient record review, one cannot rely on the existing reporting systems within hospitals.

Complaints Against Family Physicians Submitted to Disciplinary Tribunals in the Netherlands: Lessons for Patient Safety

“…The literature shows little overlap in the different methods used to document the prevalence of patient safety incidents. 9,10,22 Prevalence of incidents cannot be calculated from this study because of the relatively small sample of disciplinary law verdicts and the few complaints researched. Currently the medical record review offers the best means of assessing the prevalence of patient safety incidents.…”

“…Various methods can be used to identify patient safety incidents, but overlap between methods is limited. 9,10 The aim of the present study was to describe and examine complaints against family physicians submitted to Dutch disciplinary tribunals with a view to improving patient safety.…”

Patient Safety Incidents During Overnight Polysomnography: A Five-Year Observational Cohort Study

“…Some estimates suggest that such voluntary reporting systems account for less than 10% of all safety incidents that occur in the acute care setting. 9,10 Learning about safety incidents via patient reports, via office of patient affairs, surveys, audits using "trigger tools" or random review, and automated review of electronic medical records are all tools that have been more fully developed in the inpatient safety programs, but not yet systematically applied in outpatient venues.…”

Complaints concerning communication reported by users of healthcare in a specific region in Sweden

“…The investigation is important in terms of individualised and holistic care which addresses patient autonomy and safety, access to care, and the quality of healthcare for all individuals and their families. [9,10] It has been shown that criticism from patients [11,12] or from healthcare professionals in the wake of adverse events is underreported. [12,13] However, previous systematic literature study [14] focused on patients complaints found that the most common problems were about treatment and communication.…”

“…[9,10] It has been shown that criticism from patients [11,12] or from healthcare professionals in the wake of adverse events is underreported. [12,13] However, previous systematic literature study [14] focused on patients complaints found that the most common problems were about treatment and communication. Previous qualitative research from patients end relatives perspective investigated the complaints about physicians behavior found the most common complaints were disagreement about expectations of care, distrust, perceived unavailability, [15] insufficient information, insufficient respect [8,15] and insufficient empathy.…”