Prioritising recommendations following analyses of adverse events in healthcare: a systematic review

Abstract

PurposeThe purpose of this systematic review was to identify an appropriate method—a user-friendly and validated method—that prioritises recommendations following analyses of adverse events (AEs) based on objective features.Data sourcesThe electronic databases PubMed/MEDLINE, Embase (Ovid), Cochrane Library, PsycINFO (Ovid) and ERIC (Ovid) were searched.Study selectionStudies were considered eligible when reporting on methods to prioritise recommendations.Data extractionTwo teams of reviewers performed the data extraction which was defined prior to this phase.Results of data synthesisEleven methods were identified that are designed to prioritise recommendations. After completing the data extraction, none of the methods met all the predefined criteria. Nine methods were considered user-friendly. One study validated the developed method. Five methods prioritised recommendations based on objective features, not affected by personal opinion or knowledge and expected to be reproducible by different users.ConclusionThere are several methods available to prioritise recommendations following analyses of AEs. All these methods can be used to discuss and select recommendations for implementation. None of the methods is a user-friendly and validated method that prioritises recommendations based on objective features. Although there are possibilities to further improve their features, the ‘Typology of safety functions’ by de Dianous and Fiévez, and the ‘Hierarchy of hazard controls’ by McCaughan have the most potential to select high-quality recommendations as they have only a few clearly defined categories in a well-arranged ordinal sequence.

Grading recommendations for enhanced patient safety in sentinel event analysis: the recommendation improvement matrix

“…Methods for rational grading of the quality of recommendations after SEs into high-quality or low-quality categories are lacking. 5 In a previous study, we developed and validated a basic set of criteria to determine whether recommendations found in SE analysis reports have the potential to prevent similar SEs. This was done because many of the derived recommendations from incident reports had no relation to the described SE or were formulated in such general terms that it was impossible to determine what was intended to or would change in practice.…”

“…This method should be user-friendly, and grade recommendations based on objective features. 5 In every healthcare organisation, choices have to be made since resources are limited. An objective validated method which can provide solid data for the dialogue on where to allocate resources, how risks should be weighed and prioritised and which interventions are proportional, is of the utmost importance.…”

“…In this expert consensus meeting, the data from a previous systematic review were used as the basis on which an objective dialogue in which a weighing and prioritising of these data was performed. 5 The following characteristics of the included papers were discussed: user-friendliness, was the method validated, was the method aimed at recommendations after SEs and was the method objective.…”