Using prospective clinical surveillance to identify adverse events in hospital
Open Access
- 1 March 2011
- journal article
- research article
- Published by BMJ in BMJ Quality & Safety
- Vol. 20 (9), 756-763
- https://doi.org/10.1136/bmjqs.2010.048694
Abstract
Background To improve patient safety, organisations must systematically measure avoidable harms. Clinical surveillance—consisting of prospective case finding and peer review—could improve identification of adverse events (AEs), preventable AEs and potential AEs. The authors sought to describe and compare findings of clinical surveillance on four clinical services in an academic hospital. Methods Clinical surveillance was performed by a nurse observer who monitored patients for prespecified clinical events and collected standard information about each event. A multidisciplinary, peer-review committee rated causation for each event. Events were subsequently classified in terms of severity and type. Results The authors monitored 1406 patients during their admission to four hospital services: Cardiac Surgery Intensive Care (n=226), Intensive Care (n=211), General Internal Medicine (n=453) and Obstetrics (n=516). The authors detected 245 AEs during 9300 patient days of observation (2.6 AEs per 100 patient days). 88 AEs (33%) were preventable. The proportion of patients experiencing at least one AE, preventable AE or potential AE was 13.7%, 6.1% and 5.3%, respectively. AE risk varied between services, ranging from 1.4% of Obstetrics to 11% of Internal Medicine and Intensive Care patients experiencing at least one preventable AE. The proportion of patients experiencing AEs resulting in permanent disability or death varied between services: ranging from 0.2% on Obstetrics to 4.9% on Cardiac Surgery Intensive Care. No services shared the most frequent AE type. Conclusions Using clinical surveillance, the authors identified a high risk of AE and significant variation in AE risks and subtypes between services. These findings suggest that institutions will need to evaluate service-specific safety problems to set priorities and design improvement strategies.Keywords
This publication has 44 references indexed in Scilit:
- Use of National Surgical Quality Improvement Program Data as a Catalyst for Quality ImprovementJournal of the American College of Surgeons, 2007
- Ottawa Hospital Patient Safety Study: incidence and timing of adverse events in patients admitted to a Canadian teaching hospitalCMAJ : Canadian Medical Association Journal, 2004
- Adverse events in acute care: An integrative literature reviewResearch in Nursing & Health, 2003
- Adverse drug event trigger tool: a practical methodology for measuring medication related harmQuality and Safety in Health Care, 2003
- A look into the nature and causes of human errors in the intensive care unitQuality and Safety in Health Care, 2003
- Detecting Adverse Events Using Information TechnologyJournal of the American Medical Informatics Association, 2003
- Adverse events in health care: issues in measurementQuality in health care : QHC, 2000
- Screening for adverse eventsJournal of Evaluation in Clinical Practice, 1999
- Reasons for not reporting adverse incidents: an empirical studyJournal of Evaluation in Clinical Practice, 1999
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987