A comparison of hospital adverse events identified by three widely used detection methods

Abstract

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.

Adverse events in the intensive care unit: impact on mortality and length of stay in a prospective study

“…The proportion of deaths in intensive care in this study was similar to that of the Canadian study 13 (25%; 95%CI: [19][20][21][22][23][24][25][26][27][28][29][30][31] in that patients with adverse events had higher odds of dying in intensive care. A cohort study carried out in French ICUs identified a positive association between occurrence of two or more adverse events and death (OR = 3.09; 95%CI: 1.30-7.36) 14 .…”

“…This divergence is in part due to operational differences in adverse event and damage definitions present in the International Classification for Patient Safety (ICPS) 10 on which this study was based. Additionally, the trigger tool proposed by the IHI 25 are considered highly sensitive for identifying events 29 . A study carried out in the United States that combined different strategies verified that 20.2% of patients had adverse events (3.62 adverse events per 100 patients-day) 1 .…”

Identification by families of pediatric adverse events and near misses overlooked by health care providers

“…7 As with the present study, a previous analysis of the congruence between adverse event reports from health care providers, discharge abstracts and a trigger tool showed that adverse events identified by one method were unlikely to be reported by another. 13 Some of the discrepancy in reports between the two reporting techniques in the study reported here is likely attributable to the reliance of the health care provider reporting system on a passive surveillance technique, whereas the family reporting system involved actively querying each family at the time of the patient's discharge from hospital.…”

The Relationship Between Hospital Systems Load and Patient Harm

“…Previous comparisons of results from different methods of finding adverse events (provider self-reports, patient safety indicators [PSIs], global trigger tool [GTT]) concluded that there is very little overlap in the types of events detected by each method and that each approach has strengths and limitations. 26,27 Comparing the results of triggered chart reviews with either PSIs or provider self-reports shows that provider reporting captured more of the events identified with chart review (9 of the 65 events) than those captured by the PSIs calculated on administrative data (2 of the 65). 27 Comparing PSIs and provider reported adverse events produced an interesting pattern in the overlap.…”