Int J Qual Health Care-2012-Caminiti-114-20 (original) (raw)
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A comparison of hospital adverse events identified by three widely used detection methods
International Journal for Quality in Health Care, 2009
Objective. Determine the degree of congruence between several measures of adverse events. Design. Cross-sectional study to assess frequency and type of adverse events identified using a variety of methods. Setting. Mayo Clinic Rochester hospitals. Participants. All inpatients discharged in 2005 (n ¼ 60 599). Interventions. Adverse events were identified through multiple methods: (i) Agency for Healthcare Research and Qualitydefined patient safety indicators (PSIs) using ICD-9 diagnosis codes from administrative discharge abstracts, (ii) providerreported events, and (iii) Institute for Healthcare Improvement Global Trigger Tool with physician confirmation. PSIs were adjusted to exclude patient conditions present at admission. Main outcome measure. Agreement of identification between methods. Results. About 4% (2401) of hospital discharges had an adverse event identified by at least one method. Around 38% (922) of identified events were provider-reported events. Nearly 43% of provider-reported adverse events were skin integrity events, 23% medication events, 21% falls, 1.8% equipment events and 37% miscellaneous events. Patients with adverse events identified by one method were not usually identified using another method. Only 97 (6.2%) of hospitalizations with a PSI also had a provider-reported event and only 10.5% of provider-reported events had a PSI. Conclusions. Different detection methods identified different adverse events. Findings are consistent with studies that recommend combining approaches to measure patient safety for internal quality improvement. Potential reported adverse event inconsistencies, low association with documented harm and reporting differences across organizations, however, raise concerns about using these patient safety measures for public reporting and organizational performance comparison.
Validation of Hospital Administrative Dataset for adverse event screening
Quality & safety in health care, 2010
To assess whether the Belgian Hospital Discharge Dataset (B-HDDS) is a valid source for the detection of adverse events in acute hospitals. Retrospective review of 1515 patient records in eight acute Belgian hospitals for the year 2005. Predictive value of the B-HDDS and medical record reviews and degree of correspondence between the B-HDDS and medical record reviews for five indicators: pressure ulcer, postoperative pulmonary embolism or deep vein thrombosis, postoperative sepsis, ventilator-associated pneumonia and postoperative wound infection. Postoperative wound infection received the highest positive predictive value (62.3%), whereas postoperative sepsis and ventilator-associated pneumonia were rated as only 44.2% and 29.9% respectively. Excluding present on admission from the screening substantially decreased the positive predictive value of pressure ulcer from 74.5% to 54.3%, as pressure ulcers present on admission were responsible for more B-HDDS-medical record mismatches t...
Measurement of adverse events using 'incidence flagged' diagnosis codes
Journal of Health Services Research & Policy, 2006
n ¼ 1, 645,992) to estimate the rates of adverse events using International Classi¢cation of Diseases 10th Revision Australian Modi¢cation codes alone and in combination with an 'incidence' data £ag indicating complicating diagnoses which arise after hospitalization; rates of incidence and pre-existing adverse events, and rates for same-day and multi-day admissions.
2014
Background: Several review studies have shown that 3.4% to 16.6% of patients in acute care hospitals experience one or more adverse events. Adverse events (AEs) in hospitals constitute a significant problem with serious consequences and a challenge for public health. The occurrence of AEs in Portuguese hospitals has not yet been systematically studied. The main purpose of this study is to estimate the incidence, impact and preventability of adverse events in Portuguese hospitals. It is also our aim to examine the feasibility of applying to Portuguese acute hospitals the methodology of detecting AEs through record review, previously used in other countries. Methods: This work is based on a retrospective cohort study and was carried out at three acute care hospitals in the Administrative Region of Lisbon. The identification of AEs and their impact was done using a two-stage structured retrospective medical records review based on the use of 18 screening criteria. A random sample of 1,669 medical records (representative of 47,783 hospital admissions) for the year 2009 was analyzed. Results: The main results found in this study were an incidence rate of 11.1% AEs, of which around 53.2% were considered preventable. The majority of AEs were associated with surgical procedures (27%), drug errors (18.3%) and hospital acquired infections (12.2%). Most AEs (61%) resulted in minimal or no physical impairment or disability, and 10.8% were associated with death. In 58.6% of the AEs' cases, the length of stay was prolonged on average 10.7 days. Additional direct costs amounted to €470,380.00. Conclusion: The magnitude of these results was critical, reinforcing the need of more detailed studies in this area. The knowledge of the incidence and nature of AEs that occur in hospitals should be seen as a first step towards the improvement of quality and safety in health care.
Adverse Events ‒ One of the Most Important Health Care Quality Indicators: A Case Study
The aim of study: to evaluate inpatients, experienced adverse events (AE) in Klaipeda university hospital (KUH) contingent, healthcare profiles, location and causal factors, the degree of risk, possibility to avoide its, and to compare assessment of doctors and experts, and estimate their changes in different analyzed periods. Material and methods. The study carried out by analyzing the AE reporting forms in KUH at 2000-2014time period. Exploring and comparing 1690 patients, experienced AE data by age, gender, health care profile, the reasons. Results. The survey showed that AE was 0.3 % of hospitalized patients, most of them (54.9 %) ‒ associated with surgery. The largest group of AE ‒ repeated operations (44.8 %), related to childbirth AE (26.2 %) and related to infection ‒ (13.1 %). Almost half (43.2 %) AE were medium risk, one-third (33.8 %) ‒ minimal and one-fifth (21.6 %) ‒ high risk. Doctors (nurses) and experts opinions on the major causative factors of AE ‒ the individual characteristics of the patients (88.5 % and 90.3 %) basically was similar. However, due to the individual characteristics of doctors (nurses) ‒ experts often (14.2 %) could see them as causal factor than doctors or nurses (9.8 %). Due possibility of AE avoidance ‒ doctors (nurses) and experts opinion that almost half of them (44.7 % and 48.8 %) were avoidable was the same, but stood for full possibility of avoidance (11.2 % doctors (nurses) and 16.9 % experts) and complete inevitability (44.1 % doctor (nurses) and 34.3 % experts) of AE. Conclusions: Long-term operating adverse events reporting and registration system and analysis showed that adverse events in KUH is much less than in comparable large multiprofile hospitals of other countries. The structure of AE have advantages with structure in other countries ‒ the most adverse events related to surgery, infections, nursing, but there are significant differences ‒ reported little adverse events related to drugs, diagnostics, and a small number of falls compared with many births related AE. The majority ‒ almost four fifths of the AE was minimal or medium risk, one-fifths ‒ high-risk. The AE related 289 with deaths were few. The main causal factors of AE ‒ individual characteristics of the patients and the doctors, and team work failure. A two-thirds of AE could be fully or partially prevented.
Monitoring adverse events in Norwegian hospitals from 2010 to 2013
BMJ open, 2015
To describe how adverse event (AE) rates were monitored and estimated nationally across all Norwegian hospitals from 2010 to 2013, and how they developed during the monitoring period. Monitoring was based on medical record review with Global Trigger Tool (GTT). All publicly and privately owned hospitals were mandated to review randomly selected medical records to monitor AE rates. The initiative was part of the Norwegian patient safety campaign, launched by the Norwegian Ministry of Health and Care Services. It started in January 2011 and lasted until December 2013. 2010 was the baseline for the review. One of the main aims of the campaign was to reduce patient harm. To standardise the medical record reviews in all hospitals, GTT was chosen as a standard method. GTT teams from all hospitals reviewed 40 851 medical records randomly selected from 2 249 957 discharges from 2010 to 2013. Data were plotted in time series for local measurement and national AE rates were estimated, plotted...
Identification of Adverse Events in Inpatients: Results of a Preliminary Survey in Japan
Asian Pacific Journal of Disease Management, 2010
To examine the feasibility of detecting adverse events (AEs). A two-stage retrospective review of medical records. Seven hundred cases discharged during fiscal year 2002 were randomly selected from among inpatients, excluding psychiatric ward patients, hospitalized at seven acute-care hospitals. In the first stage of the review, trained nurse reviewers examined the medical records using 18 screening criteria to identify potential AEs. A nurse supervisor then reviewed all the cases judged as being criteria-negative by the first set of nurse reviewers and corrected the judgements as necessary. During the second stage of the review, a physician review team confirmed the occurrence, and categorized the AEs. Of the 700 cases, 79 (11.3%) cases were judged to have had AEs. Of the 79 cases, the AEs were the reason for the index admission in 26 cases, and the AEs occurred during the index admission in 53 cases. It was also judged that the AEs were highly preventable in 21 cases. Our judgement was consistent with that in the Australian survey. We confirmed the feasibility of the two-stage review process to detect AEs. To improve patient safety in Japanese hospitals, a nationwide survey, using this methodology, is necessary to fully understand the epidemiology of AEs, including the types of AEs and the contributory factors.