Design of a medical record review study on the incidence and preventability of adverse events requiring a higher level of care in Belgian hospitals

Abstract

BackgroundAdverse events are unintended patient injuries that arise from healthcare management resulting in disability, prolonged hospital stay or death. Adverse events that require intensive care admission imply a considerable financial burden to the healthcare system. The epidemiology of adverse events in Belgian hospitals has never been assessed systematically.FindingsA multistage retrospective review study of patients requiring a transfer to a higher level of care will be conducted in six hospitals in the province of Limburg. Patient records are reviewed starting from January 2012 by a clinical team consisting of a research nurse, a physician and a clinical pharmacist. Besides the incidence and the level of causation and preventability, also the type of adverse events and their consequences (patient harm, mortality and length of stay) will be assessed. Moreover, the adequacy of the patient records and quality/usefulness of the method of medical record review will be evaluated.DiscussionThis paper describes the rationale for a retrospective review study of adverse events that necessitate a higher level of care. More specifically, we are particularly interested in increasing our understanding in the preventability and root causes of these events in order to implement improvement strategies. Attention is paid to the strengths and limitations of the study design.

One Fourth of Unplanned Transfers to a Higher Level of Care Are Associated With a Highly Preventable Adverse Event

“…Based on these findings, a sample size of 1,000 patient years or 365,000 patient days at risk would provide a CI of approximately 20% (± 10% around the estimate). As the total yearly number of inpatient days (excluding palliative, neonatal, pediatric, and 1 day-stay admissions) for the six participating hospitals was 760,057 (year 2010), the required sample size corresponds to an inclusion period of 6 months ( 32 ). The data obtained in the pilot study were not included in this study.…”

Sobrecarga de trabalho da Enfermagem e incidentes e eventos adversos em pacientes internados em UTI

“…Dano implica em prejuízo na estrutura ou nas funções do corpo e/ou qualquer efeito deletério daí resultante, incluindo lesão, doença, sofrimento, incapacidade ou morte, e pode ser físico, social ou psicológico. Os eventos adversos e incidentes são relevantes indicadores de qualidade, fornecendo informações imprescindíveis para o planejamento de um sistema de saúde mais seguro (4) .…”

“…Na análise dos fatores relacionados aos EA em pacientes em UTI, destaca-se o papel da Enfermagem, uma vez que este é o local em que há maior demanda para as atividades dos enfermeiros e há exigência de ações rápidas e de observação continuada por parte desses profissionais (4) . As condições de trabalho do pessoal de enfermagem, caracterizadas, por vezes, pela sobrecarga de trabalho e pela jornada em regime de plantões são fatores de risco para a segurança do paciente (12) .…”

Standardization of the duty shift in a General Adult Intensive Care Unit

“…Adverse events are incidents with damage or impairment in the structure or functions of the organism, including injury, disability or death, but they can be used as indicators of quality, allowing the planning of a health system safer, if necessary, risk management, event notifications and focus on safety culture (26) .…”