Trends in Adverse Event Rates in Hospitalized Patients, 2010-2019

Eldridge, Noel; Wang, Yun; Metersky, Mark L.; Eckenrode, Sheila; Mathew, Jasie; Sonnenfeld, Nancy; Perdue-Puli, Jade; Hunt, David; Brady, Paul; McGann, Paul; Grace, Erin; Rodrick, David; Drye, Elizabeth E.; Krumholz, Harlan M.

doi:10.1001/jama.2022.9600

Cited by 58 publications

(45 citation statements)

References 14 publications

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“…The analysis of the United States national database of medical records showed a significant decrease in the rate of adverse events following major surgical procedures between 2010 and 2019. 86 In concordance, the rate of any complication until discharge after bariatric surgery decreased from 10.6% in 2012 to 7.1% in 2017 in Switzerland, while the annual bariatric caseload increased by approximately 50%. 87 Future research in the field of surgical quality should focus on implementing real-time feedback of any deviation from the planned postoperative course to the surgical team, as well as on the better prediction and prevention of surgical complications.…”

Section: Future Outlookmentioning

confidence: 82%

Classification of Adverse Events in Adult Surgery

2023

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Successful surgery combines quality (achievement of a positive outcome) with safety (avoidance of a negative outcome). Outcome assessment serves the purpose of quality improvement in health care by establishing performance indicators and allowing the identification of performance gaps. Novel surgical quality metric tools (benchmark cutoffs and textbook outcomes) provide procedure-specific ideal surgical outcomes in a subgroup of well-defined low-risk patients, with the aim of setting realistic and best achievable goals for surgeons and centers, as well as supporting unbiased comparison of surgical quality between centers and periods of time. Validated classification systems have been deployed to grade adverse events during the surgical journey: (1) the ClassIntra classification for the intraoperative period; (2) the Clavien–Dindo classification for the gravity of single adverse events; and the (3) Comprehensive Complication Index (CCI) for the sum of adverse events over a defined postoperative period. The failure to rescue rate refers to the death of a patient following one or more potentially treatable postoperative adverse event(s) and is a reliable proxy of the institutional safety culture and infrastructure. Complication assessment is undergoing digital transformation to decrease resource-intensity and provide surgeons with real-time pre- or intraoperative decision support. Standardized reporting of complications informs patients on their chances to realize favorable postoperative outcomes and assists surgical centers in the prioritization of quality improvement initiatives, multidisciplinary teamwork, surgical education, and ultimately, in the enhancement of clinical standards.

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Section: Future Outlookmentioning

confidence: 82%

Classification of Adverse Events in Adult Surgery

2023

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“…In fact, there is some good news from the USA suggesting that improvement efforts (likely aided by secular trends) have reduced rates of 21 adverse events in that country over the last decade. 17 However, the poor application of QI methods has the potential to harm. A more thoughtful approach, considering the lessons learnt both in and out of healthcare, and heeding the recommendations highlighted in box 1, may serve to improve the quality of QI.…”

Section: Editorialmentioning

confidence: 99%

“…We are not arguing here that QI should be abandoned altogether. In fact, there is some good news from the USA suggesting that improvement efforts (likely aided by secular trends) have reduced rates of 21 adverse events in that country over the last decade 17. However, the poor application of QI methods has the potential to harm.…”

mentioning

confidence: 99%

Overcoming the ‘self-limiting’ nature of QI: can we improve the quality of patient care while caring for staff?

Lawton

Thomas

2022

BMJ Qual Saf

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“…Very recently, a significant decline has been reported in the adverse event rates according to medical records of patients hospitalized in the USA for acute myocardial infarction, heart failure, pneumonia, and major surgical procedures between the years of 2010 and 2019, which undoubtedly is a cause for hope 18 .…”

mentioning

confidence: 99%

Medical errors and communication

Román-Terán¹,

Gómez‐Huelgas²

2022

SJMED

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The interest sparked by "medical error" can be seen in the medical literature on the PubMed search engine. In a search of entries under this heading conducted on July 12, 2022, 156,899 references are found, of which 63,322 correspond to the last ten years and 5760 to reviews. Of them, 1880, 788, and 87 are publications in Spanish, respectively.In 1999, the World Health Organization (WHO) and the Institute of Medicine's (IOM) Committee on Quality of Health Care in America published landmark reports which, using data from the states of Colorado, Utah, and New York, estimated that nearly 100,000 patients died each year from problems arising from medical errors 1,2 . Extrapolating the results of these reports to North American health-care databases, it can be concluded that around 3% (2.9%-3.7%) of hospitalizations would have experienced adverse side effects secondary to medical errors made during the hospitalization and that between 6.6% and 13.6% of these errors would have had a fatal outcome. The reports stated that one of every two incidents could have been avoided. At that time, these provocative reports generated a great deal of debate, both in public opinion and in the medical field.If we perform the theoretical exercise of transferring these results to Spain's Basic Minimum Data Set (CMBD, for its initials in Spanish) (a registry of specialized healthcare activity from the Ministry of Health), in 1999, there would have been no < 50,000 avoidable adverse events due to medical error among hospitalized patients in our country, of which between 4000 and 5000 would have been fatal 3 .Based on these data, it is not too bold to claim that medical error is among the main causes of death in Western societies, causing a similar number or even more deaths than traffic accidents or breast cancer, and many more than due to acquired immunodeficiency syndrome.Later analyses -which included new works based on different methods that attempted to update the data reported by the IOM in 1999 as they considered them limited and out-of-date-considerably increased the number of medical errors. These analyses asserted that medical error is the third leading cause of death in the United States of America (USA), behind only cardiovascular diseases and cancer, and that they account for more than seven times the number of fatalities due to traffic accidents or firearms 4,5 . Classen et al. describe a medical error rate of 1.13% which, applied to Medicare data from the period from 2013 to 2015, would entail more than 400,000 deaths per year in the USA. This is four times higher than the estimate made by the IOM in 1999 6 .The fact that medical error is very likely underestimated makes this even more worrying. On the one hand, medical errors, whether they lead to the patient's death or not, are not classified as such in the International Classification of Diseases 9 th or 10 th edition (ICD-9, ICD-10). Therefore,

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Trends in Adverse Event Rates in Hospitalized Patients, 2010-2019

Cited by 58 publications

References 14 publications

Classification of Adverse Events in Adult Surgery

Classification of Adverse Events in Adult Surgery

Overcoming the ‘self-limiting’ nature of QI: can we improve the quality of patient care while caring for staff?

Medical errors and communication

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