The incidence of adverse events in Swedish hospitals: a retrospective medical record review study

Soop, Michael; Fryksmark, Ulla; Köster, Max; Haglund, Bengt

doi:10.1093/intqhc/mzp025

Cited by 271 publications

(268 citation statements)

References 12 publications

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“…Numerous studies in different countries have been conducted using this approach in the last years. These studies revealed adverse event rates of 5-15% of all acute care hospital admissions [4][5][6][7][8] . Approximately 50% of events were deemed preventable [5] .…”

Section: Health Care As a Risk: The Magnitude Of The Safety Problemmentioning

confidence: 99%

Patient Safety: What Is It All about?

Schwappach

2015

Contributions to Nephrology

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Patient safety is a major concern in health care systems worldwide. Patients with serious conditions, multimorbidity, and with intense and fragmented health care utilization, like end-stage renal disease (ESRD) patients, are at increased risk for suffering adverse events. In this chapter, the fundamental terms and concepts of patient safety are introduced. Essential epidemiological data relating to the frequency of adverse events and medical errors are provided. The chapter reports important safety threats for ESRD patients and describes examples of key innovations which contribute to patient safety. Recommendations and risk reduction strategies to improve care of ESRD patients are presented.

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Section: Health Care As a Risk: The Magnitude Of The Safety Problemmentioning

confidence: 99%

Patient Safety: What Is It All about?

Schwappach

2015

Contributions to Nephrology

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“…When adverse events are not controlled or prevented, they lead to long-term hospitalization, death, disability at discharge time, or changes in primary treatments (9,10). In developed countries, the incident ranges from 3.5% in the U.S. (11), 9.2% in Canada (12), to 12.3% in Sweden (13).…”

Section: Introductionmentioning

confidence: 99%

The Association of Nursing Workloads, Organizational, and Individual Factors with Adverse Patient Outcome

Abadi¹,

Akbari²,

Akbari³

et al. 2016

Iran Red Crescent Med J

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Introduction: Adverse patient outcomes have become a big concern in the quality of healthcare. Different factors can have an impact on the variety and rate of adverse patient outcomes. Objectives: The present study aimed at determining the rate of patient safety during events and evaluating nursing workloads as well as identifying the main factors that affect the incidence rate of patient safety events among nurses. Methods: This cross-sectional study was conducted on 293 nurses working in 24 wards of Baqiyatallah hospital in Tehran, Iran, in 2016. The sampling method was stratified random sampling. Data were collected using a self-administered questionnaire, which was classified into 4 subtitles: Individual and organizational characteristics, perceived subjective, objective workloads, and some patient safety events during the past 6 months. Binary and multiple regressions were used to survey the relationship between variables using the SPSS Version 23 software. Results: Bloodstream infection, pressure ulcer, and patient falls were the most reported adverse outcomes during the past 6 months with 76.1%, 66.2%, and 59%, respectively. At least one of the 6 adverse outcomes was reported by nurses within the range of 45%-77%. Of all individual characteristics, the only significant relationship occurred between work experience and bloodstream infection (P value = 0.28 and 0.32). No significant relationship was detected between adverse patient outcomes and objective workloads. Regression models revealed that the subjective workload of adverse patient outcomes increased with making adjustments in the individual and organizational characteristics. The incidence rates of adverse outcomes were 5.69-9.78 times more than the fixed shifts in all rotational shift works. Conclusions: The nurses reported a high incidence rate of all patient safety events, and the results revealed that the objective workload could not be a predictor for patient adverse events. According to the findings, subjective workload and work shift were significantly related to the incidence rate of adverse patient events. In conclusion, good regulation of sleep-wake cycles can be an important factor for decreasing the rate of adverse patient events.

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“…31 In stage 2, using the modular review form 2 (MRF2), doctors trained in the use of a standard set of questions analyse positively screened records in detail to determine whether or not they contain evidence of an AE. The basic method has been followed in all the major epidemiological studies, 14,16,[32][33][34][35][36][37][38][39] although there have been modifications to the review form and data capture methods. 30 Previous work in a UK setting, 16,24 assessing the sensitivity of the two-stage review process, reported a sensitivity of 92% and a specificity of 62%.…”

Section: Retrospective Case Note Reviewmentioning

confidence: 99%

Measuring harm and informing quality improvement in the Welsh NHS: the longitudinal Welsh national adverse events study

Mayor

Baines

Vincent

et al. 2017

Health Serv Deliv Res

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Background, objectives and settingDespite global activity over the past 15 years to improve patient safety, the measurement of adverse events (AEs) remains challenging.ObjectivesWe aimed to obtain definitive longitudinal data on harm across NHS Wales and to compare the performance of the Global Trigger Tool (GTT) with the two-stage retrospective review process, using our findings to consolidate an approach to the ongoing surveillance of harm in Wales.Data sourcesEleven of the 13 major Welsh NHS hospitals.Review methodsThe two-stage retrospective review methodology was used to quantify harm across NHS Wales. In total, 4536 inpatient episodes were screened for AEs by research nurses. Records that were highly suggestive of AEs were further assessed by physicians. NHS-led teams undertook GTT reviews on the same case notes.ResultsAt least one AE was determined in 10.3% of episodes of care [95% confidence interval (CI) 9.4% to 11.2%] and 51.5% were preventable (95% CI 46.9% to 56.1%). The percentage of patients identified with AEs using the GTT methodology was lower, at 9.0% (95% CI 8.82% to 9.18%). Differences in AEs were evident across study sites. Methods were developed to profile the risk of AEs in individual organisations by producing signatures of harm for each NHS site. Analysis indicated that neither the GTT nor the two-stage process was a candidate tool for routine surveillance, and a hybrid one-stage tool (Harm2), based on phase 1 findings, was developed for ongoing AE monitoring. Using the Harm2 tool, AEs were identified in 371 out of 3352 randomly selected discharge reviews (11.3%, 95% CI 10.2% to 12.4%), and 59.6% (95% CI 55.3 to 63.9) of these were preventable. In a cohort of randomly selected deceased patient reviews, at least one AE was determined in 315 out of 1018 admissions (30.1%, 95% CI 28.1% to 33.8%), and 61.7% (95% CI 57.5% to 65.9%) of these were preventable. Factors associated with AEs in the randomly selected discharge reviews included having peripheral vascular disease [odds ratio (OR) 2.52], hemiplegia (OR 2.27) or dementia (OR 2.27). No association with chronic disease was identified in the deceased episodes of care.LimitationsThe dependence on our health service partners in identifying notes to be reviewed, along with the small sample examined each month, limits the generalisability of these findings and rates were not standardised for hospital and size and level of services provided. We cannot rule out the possibility that the rates we report may be underestimated.ConclusionThe extent of harm detected across NHS Wales using both the two-stage retrospective review process and the new Harm2 tool conforms to the findings in the literature, but this is the first longitudinal study using these methods. With training and using a structured review process, non-physician reviewers can undertake case note review efficiently and effectively, and the rates of AEs and of the preventability and the breakdown of problems in care conform to those reported in studies in which physicians undertake these classifications. Whether the patient died or was discharged alive significantly influences the rate and composition of AEs. The Harm2 tool performed with moderate reliability in the determination of AEs.Future workFuture large-scale studies should attempt to specify types of AEs, such as hospital-acquired infections and surgical complications, to enable the surveillance of the specific types of harm as well as the overall level of AEs. In the longer term, we need to automate harm surveillance and set measures of harm alongside measures of the beneficial effects of health care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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The incidence of adverse events in Swedish hospitals: a retrospective medical record review study

Cited by 271 publications

References 12 publications

Patient Safety: What Is It All about?

Patient Safety: What Is It All about?

The Association of Nursing Workloads, Organizational, and Individual Factors with Adverse Patient Outcome

Measuring harm and informing quality improvement in the Welsh NHS: the longitudinal Welsh national adverse events study

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