Incidence of adverse events in Sweden during 2013–2016: a cohort study describing the implementation of a national trigger tool

Abstract

ObjectivesTo describe the implementation of a trigger tool in Sweden and present the national incidence of adverse events (AEs) over a 4-year period during which an ongoing national patient safety initiative was terminated.DesignCohort study using retrospective record review based on a trigger tool methodology.Setting and participantsPatients ≥18 years admitted to all somatic acute care hospitals in Sweden from 2013 to 2016 were randomised into the study.Primary and secondary outcome measuresPrimary outcome measure was the incidence of AEs, and secondary measures were type of injury, severity of harm, preventability of AEs, estimated healthcare cost of AEs and incidence of AEs in patients cared for in another type of unit than the one specialised for their medical needs (‘off-site’).ResultsIn a review of 64 917 admissions, the average AE rates in 2014 (11.6%), 2015 (10.9%) and 2016 (11.4%) were significantly lower than in 2013 (13.1%). The decrease in the AE rates was seen in different age groups, in both genders and for preventable and non-preventable AEs. The decrease comprised only the least severe AEs. The types of AEs that decreased were hospital-acquired infections, urinary bladder distention and compromised vital signs. Patients cared for ‘off-site’ had 84% more preventable AEs than patients cared for in the appropriate units. The cost of increased length of stay associated with preventable AEs corresponded to 13%–14% of the total cost of somatic hospital care in Sweden.ConclusionsThe rate of AEs in Swedish somatic hospitals has decreased from 2013 to 2016. Retrospective record review can be used to monitor patient safety over time, to assess the effects of national patient safety interventions and analyse challenges to patient safety such as the increasing care of patients ‘off-site’. It was found that the economic burden of preventable AEs is high.

Adverse events in psychiatry: a national cohort study in Sweden with a unique psychiatric trigger tool

“…The majority of AEs as well as AEs causing severe or catastrophic harm affected women and for the latter group it was seen in all areas of AEs. This was a surprising finding and something that differs from what is known from somatic care [16]. Although sex differences have been observed across many psychiatric diseases [30], our cohort had equally distributed sex.…”

“…In comparison to somatic hospital healthcare with increasing frequencies of AEs with age [16], the equal distribution of AEs in different age groups is striking. In the present study, only 15% of the patients were 65 years or older.…”

“…In the present study, only 15% of the patients were 65 years or older. The corresponding figure for the Swedish somatic hospital healthcare was 66% [16]. One possible explanation for this difference in age distribution in somatic and psychiatric hospital care is that mental diseases usually have an earlier onset than somatic diseases.…”

“…Most studies on the patient safety trigger tool have been undertaken in adult hospital somatic care. In Sweden, the trigger tool methodology has been used for somatic care at a national level since 2012 [16,17].…”

Identifying no-harm incidents in home healthcare: a cohort study using trigger tool methodology

“…Structured retrospective record review (RRR) using a trigger tool (TT) is a valid and thorough method for measuring the incidence of AEs, [9][10][11] and has successfully been developed and used for identifying adverse events (AEs) in different kind of specialties in in-hospital care [12][13][14]. One well described TT is the Global Trigger Tool (GTT) [15], commonly used in acute inpatient care.…”