Monitoring adverse events in Norwegian hospitals from 2010 to 2013

Abstract

ObjectivesTo 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).SettingAll 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.MethodTo 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 and monitored.ResultsAE rates were estimated and published nationally from 2010 to 2013. Estimated AE rates in severity categories E-I decreased significantly from 16.1% in 2011 to 13.0% in 2013 (−3.1% (95% CI −5.2% to −1.1%)).ConclusionsMonitoring estimated AE rates emerges as a potential element in national systems for patient safety. Estimated AE rates in the category of least severity decreased significantly during the first 2 years of the monitoring.

Exploring similarities and differences in hospital adverse event rates between Norway and Sweden using Global Trigger Tool

“…Other studies have presented results for regions and healthcare systems, 14 30 31 as well as subgroups at national level. 23 International comparisons of levels of patient safety are of great interest as a means to study organisational development in healthcare.…”

“…14 The category F-I had previously been used in the American study of AEs among Medicare beneficiaries. 23 Both compounded categories were applied in the comparison of Norwegian and Swedish AE rates.…”

“…4 18 Evidence of AE rates from other countries created an additional momentum in Norway to facilitate, so that the local GTT data could be used to estimate national AE rates. 14 In the Swedish campaign, it was decided to use GTT rather than the HMPS method as GTT is not just a tool for measurement but also a tool for learning and patient safety improvement work locally. During planning and implementation of the GTT tool, experiences were exchanged in expert meetings and correspondence within the network derived from the Nordic Council of Ministers.…”

Adverse events in hospitalised cancer patients: a comparison to a general hospital population

“…Since 2010, all hospitals in Norway are required to review a minimum of 20 randomly selected medical records per month using the IHI GTT method [11]. Nordland Hospital Trust chose from the start to review 140 records monthly to achieve more accurate measurement and better support for local improvement initiatives [12].…”

An evaluation by the Norwegian Health Care Supervision Authorities of events involving death or injuries in maternity care

“…Several international studies have shown that adverse events occur in nearly 10% of hospital admissions, and of these, 40%‐50% could have been prevented . In Norway, adverse events occur in 7%‐8% of admissions . Few studies have investigated adverse events in maternity units, but 1 study in Spain showed that adverse events were experienced by 3.6% of pregnant women admitted to a hospital …”