Variation between hospitals and reviewers in detection of adverse events identified through medical record review in Korea

Abstract

Objectives This study utilized the method of medical record review to determine characteristics of adverse events that occurred in the inpatient units of hospitals in Korea as well as the variations in adverse events between institutions. Design A two-stage retrospective medical record review was conducted. The first stage was a nurse review, where two nurses reviewed medical records of discharged patients to determine if screening criteria had been met. In the second stage, two physicians independently reviewed medical records of patients identified in the first stage, to determine whether an adverse event had occurred. Setting Inpatient units of six hospitals. Participants Medical records of 2,596 patients randomly selected were reviewed in the first stage review. Intervention(s) N/A. Main Outcome Measure(s) Adverse events. Results A total of 277 patients (10.7%) were confirmed to have had one or more adverse event(s), and a total of 336 adverse events were identified. Physician reviewers agreed about whether an adverse event had occurred for 141 patients (5.4%). The incidence rate of adverse events was at least 1.3% and a maximum of 19.4% for each hospital. Most preventability scores were less than four points (non-preventable), and there were large variations between reviewers and institutions. Conclusions Given the level of variation in the identified adverse events, further studies that include more medical institutions in their investigations are needed, and a third-party committee should be involved to address the reliability issues regarding the occurrence and characteristics of the adverse events.

Feasibility of Capturing Adverse Events From Insurance Claims Data Using International Classification of Diseases, Tenth Revision, Codes Coupled to Present on Admission Indicators

“… 19 A recent study using record reviews reported an incidence of adverse events of 10.70% in Korea. 11 On the other hand, a previous study identifying adverse events using specific ICD-10 codes (Y codes) reported lower incidence (0.20%) than in our results. 28 Although the incidence of adverse events from this study was higher than the figure reported using Y codes, our results seem to be an underestimate compared with a study using medical record review, the criterion standard for evaluating adverse events.…”

Transformational leadership as a mediator between work–family conflict, nurse‐reported patient safety outcomes, and job engagement

“…Patient safety, a vital indicator of a quality healthcare delivery system, remains an important issue that plagues many healthcare systems around the world. Despite efforts to curtail and prevent patient safety errors, a wide range of studies conducted across countries suggested that many healthcare systems are vulnerable to these errors and adverse patient events (Kim et al, 2020; Lee & Quinn, 2020). The Institute of Global Health Innovation (2019) reported that these preventable errors have caused approximately 420 million hospitalizations and 5.7 to 8.4 million lives in previous years, as well as massive economic and health concerns in many countries, particularly in underdeveloped and developing regions.…”

The Korea National Patient Safety Incidents Inquiry Survey: Characteristics of Adverse Events Identified Through Medical Records Review in Regional Public Hospitals

“…This was particularly important in the evaluation of causality and preventability scores in the second-stage review. 4,19 This study attempted to reduce the variations among reviewers in the determination and assessment of adverse events through a 3-stage review conducted by a third 9-member expert review committee with experience in related prior research or activities in the field of patient safety. The incidence rate of adverse events identified in this study was 9.9%, which is similar to the 9.2% reported in a systematic review article.…”

“…The type of adverse events was classified into 6 categories, including diagnosis-related, drugs/fluids/blood-related, patient care–related, surgery/procedural-related, infection-related, and other events. The severity was classified into the following 5 levels based on the error classification system used by the National Coordinating Council for Medication Error Reporting and Prevention 16 , 19 : level 1, “events with temporary harm requiring intervention or treatment”; level 2, “events requiring long-term hospitalization treatment”; level 3, “events with permanent harm”; level 4, “events requiring intervention to sustain life”; and level 5, “events contributing to or causing death.”…”

“… 17 , 18 Most recently, a retrospective review of medical records was conducted to identify adverse events at 6 medical institutions before a large-scale medical records review. 19 …”