Estimating the incidence of adverse events in Portuguese hospitals: a contribution to improving quality and patient safety

BMC Health Services Research

Ema S Leite³  Carla Nunes²  Florentino Serranheira¹  António Sousa Uva¹  Paulo Sousa² 

[1] CMDT – Centro de Investigação em Malária e Doenças Tropicais – Saúde Pública, Lisboa, Portugal;National School of Public Health, Universidade Nova de Lisboa, Avenida Padre Cruz, 1600-540 Lisboa, Portugal;Centro Hospitalar de Lisboa Central, Lisboa, Portugal

关键词: Adverse events;    Quality of care;    Hospitals;    Medical errors;    Patient safety;   

Others  :  1127052
DOI  :  10.1186/1472-6963-14-311

 received in 2013-09-14, accepted in 2014-07-11,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Sousa et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Thomas E, Petersen L: Measuring errors and adverse events in health care. J Gen Intern Med 2003, 18:61-67.
• [2]Landrigan CP, Parry GJ, Bones CB, Hackbarth AD, Goldmann DA, Sharek PJ: Temporal trends in rates of patient harm resulting from medical care. N Engl J Med 2012, 363(22):2124-2134.
• [3]de Vries EN, Ramrattan MA, Smorenburg SM, Gouma DJ, Boermeester MA: The incidence and nature of in-hospital adverse events: a systematic review. Qual Saf Health Care 2008, 17:216-223.
• [4]Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, Hebert L, Newhouse JP, Weiler PC, Hiatt H: The nature of adverse events in hospitalized patients: results of the Harvard medical practice study II. N Engl J Med 1991, 324:377-384.
• [5]Sousa P, Uva A, Serranheira F, Pinto F, Øvretveit J, Klazinga , Sunol R, Terris D: The patient safety journey in Portugal: challenges and opportunities from a public health perspective. Revista Portuguesa de Saúde Pública 2009, Especial 25 anos:91-106.
• [6]Hauck K, Zhao X, Jackson T: Adverse event rates as measures of hospital performance. Health Policy 2012, 104:146-154.
• [7]Sousa P: Patient safety: a necessidade de uma estratégia nacional. Acta Med Port 2006, 19:309-318.
• [8]Garrouste-Orgeas M, Philippart F, Bruel C, Max A, Lau N, Misset B: Overview of medical errors and adverse events. Annals of Intensive Care 2012, 2:2. doi:10.1186/2110-5820-2-2 BioMed Central Full Text
• [9]Institute of Medicine (IOM): To err is human: building a safer health system. Washington, DC: National Academy Press; 2000.
• [10]Vincent C, Neale G, Woloshynowych M: Adverse events in British hospitals: preliminary retrospective record review. BMJ 2001, 322:517-519.
• [11]Davis P, Lay-Yee R, Briant R, Ali W, Scott A, Schug S: Adverse events in New Zealand public hospitals I: occurrence and impact. N Z Med J 2002, 115:203-209.
• [12]Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, Etchells E, Ghali WA, Hébert P, Majumdar SR, O'Beirne M, Palacios-Derflingher L, Reid RJ, Sheps S, Tamblyn R: The Canadian adverse events study: the incidence of adverse events among hospital patients in Canada. CMAJ 2004, 170:1678-1686.
• [13]Michel P, Quenon JL, de Sarasqueta AM, Scemama O: Comparison of three methods for estimating rates of adverse events and rates of preventable adverse events in acute care hospitals. BMJ 2004, 328:199. doi:http://dx.doi.org/10.1136/bmj.328.7433.199 webcite
• [14]Aranaz-Andrés JM, Aibar-Remón C, Vitaller-Murillo J, Ruiz-López P, Limón-Ramírez R, Terol-García E: Incidence of adverse events related to health care in Spain: results of the Spanish National Study of Adverse Events. J Epidemiol Community Health 2008, 62(12):1022-1029.
• [15]Zegers M, de Bruijne MC, Wagner C, Hoonhout LH, Waaijman R, Smits M, Hout FA, Zwaan L, Christiaans-Dingelhoff I, Timmermans DR, Groenewegen PP, van der Wal G: Adverse events and potentially preventable deaths in Dutch hospitals: results of a retrospective patient record review study. Qual Safe Health Care 2009, 18:297-302.
• [16]Soop M, Fryksmark U, Köster M, Haglund B: The incidence of adverse events in Swedish hospitals: a retrospective medical record review study. Int J Qual Health Care 2009, 22:324-333.
• [17]Mendes W, Martins M, Rozenfeld S, Travassos C: The assessment of adverse events in hospitals in Brazil. Int J Qual Health Care 2009, 2:279-284.
• [18]Wilson RM, Michel P, Olsen S, Gibberd RW, Vincent C, El-Assady R, Rasslan O, Qsous S, Macharia WM, Sahel A, Whittaker S, Abdo-Ali M, Letaief M, Ahmed NA, Abdellatif A, Larizgoitia I: Patient safety in developing countries: retrospective estimation of scale and nature of harm to patients in hospitals. BMJ 2012, 324:e832. doi:10.1136/bmj.e832
• [19]da Saúde M: ACSS. Contabilidade analítica dos hospitais do SNS. Administração Central do Sistema de Saúde: Lisboa; 2011.
• [20]Zegers M, De Bruijne MC, Spreeuwenberg P, Wagner C, Van Der Wal G, Groenewegen PP: Variation in the rates of adverse events between hospitals and hospitals departments. Int J Qual Health Care 2011, 23(2):126-133.
• [21]Zegers M, de Bruijne MC, Wagner C, Groenewegen PP, Waaijman R, van der Wal G: Design of a retrospective patient record study on the occurrence of adverse events among patients in Dutch hospitals. BMC Health Serv Res 2007, 7:27-34. BioMed Central Full Text
• [22]Henriksen K, Kaplan H: Hindsight bias, outcome knowledge and adaptive learning. Qual Saf Health Care 2003, 12(Suppl 2):ii46-ii50.
• [23]Schioler T, Lipczak H, Pedersen BL: Incidence of adverse events in hospitals: a retrospective study of medical records: Danish study of adverse events. Scan J Public Health 2000, 32:324-333.
• [24]Vincent C: Patient Safety. 2nd edition. Oxford: Wiley-Blackwell; 2010.
• [25]Tsilimingras D, Rosen AK, Berlowitz DR: Patient safety in geriatrics: a call for action. J Gerontol 2003, 58:813-819.
• [26]Brown P, McArthur C, Newby L, Lay-Yee R, Davis P, Briant R: Cost of medical injury in New Zealand: a retrospective cohort study. J Health Serv Res Policy 2002, 7(Suppl 1):S29-S34.
• [27]Øvretveit J: Does Improving Quality Save Money?: A Review of Evidence of which Improvements to Quality reduce Costs to Health Service Providers. London: The Health Foundation; 2009.
• [28]Commission E: The Economic Adjustment Programme for Portugal. European Commission: Brussels; June 2011.
• [29]Parand A, Benn J, Burnett S, Pinto A, Vincent C: Strategies for sustaining a quality improvement collaborative and its patient safety gains. Int J Qual Health Care 2012, 24(4):380-390.
• [30]Ovretveit J, Klazinga N: Learning from large-scale quality improvement through comparisons. Int J Qual Health Care 2012, 24(5):463-469.
• [31]O'Leary KJ, Devisetty VK, Patel AR, Malkenson D, Sama P, Thompson WK, Landler MP, Barnard C, Williams MV: Comparison of traditional triggers tool to data warehouse based screening for identifying hospital adverse events. BMJ Qual Saf 2012, 22(2):130-138.
• [32]Hogan H, Healey F, Neale G, Thomson R, Vincent C, Black N: Preventable deaths due to problems in care in English acute hospitals: a retrospective case record review study. BMJ Qual Saf 2012, 21(9):737-745.
• [33]Parry G, Cline A, Goldmann D: Deciphering harm measurement. JAMA 2012, 307:2155-2156.
• [34]Zegers M, de Bruijne MC, Wagner C, Groenewegen PP, van der Wal G, de Vet HC: The inter-rater agreement of retrospective assessment of adverse events does not improve with two reviewers per patient record. J Clin Epidemiol 2010, 63:94-102.
• [35]Naessens JM, O'Byrne TJ, Johnson MG, Vansuch MB, McGlone CM, Huddleston JM: Measuring hospital adverse events: assessing inter-rater reliability and trigger performance of the global trigger tool. Int J Qual Health Care 2010, 22(4):266-274.
• [36]Viera A, Garrett J: Understanding interobserver agreement:the Kappa Statistic. Fam Med 2005, 37(5):360-363.
• [37]de Vet HC, Mokkink LB, Terwee CB, Hoekstra OS, Knol DL: Clinicians are right not to like Cohen’s K. BMJ 2013, 12:346:f2125. doi:10.1136/bmj.f2125