Preventable+Adverse+Events+-+Medical+Error

Studies in the United States, Australia, Canada and United Kingdom have demonstrated that preventable adverse events, caused most often by medical error, is a serious cause of injury, illness and death. Abstracts and links to these studies follow:

=Australia=

[|The Quality in Australian Health Care Study] (PDF) Medical Journal of Australia Liza Newby and John D Hamilton and South Australia revealed that 16.6% of these admissions were associated with an “adverse event”, which resulted in disability or a longer hospital stay for the patient and was caused by health care management; 51% of the adverse events were considered preventable. In 77.1% the disability had resolved within 12 months, but in 13.7% the disability was permanent and in 4.9% the patient died.
 * Authors**: Ross McL Wilson, William B Runciman, Robert W Gibberd, Bernadette T Harrison,
 * Abstract**: A review of the medical records of over 14 000 admissions to 28 hospitals in New South Wales

[|The safety of Australian healthcare: 10 years after QAHCS] Authors: Ross McL Wilson and Martin B Van Der Weyden Abstract: N/A - Followup editorial 10 years after original report = = = = =Canada=

[|The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada] PDF Canadian Medical Association Journal Ed Etchells, William A. Ghali, Philip Hébert, Sumit R. Majumdar, Maeve O’Beirne, Luz Palacios-Derflingher, Robert J. Reid, Sam Sheps, Robyn Tamblyn AEs and determine their preventability.
 * Authors**: G. Ross Baker, Peter G. Norton, Virginia Flintoft, Régis Blais, Adalsteinn Brown, Jafna Cox,
 * Abstract**:
 * Background**: Research into adverse events (AEs) has highlighted the need to improve patient safety. AEs are unintended injuries or complications resulting in death, disability or prolonged hospital stay that arise from health care management. We estimated the incidence of AEs among patients in Canadian acute care hospitals.
 * Methods**: We randomly selected 1 teaching, 1 large community and 2 small community hospitals in each of 5 provinces (British Columbia, Alberta, Ontario, Quebec and Nova Scotia) and reviewed a random sample of charts for nonpsychiatric, nonobstetric adult patients in each hospital for the fiscal year 2000. Trained reviewers screened all eligible charts, and physicians reviewed the positively screened charts to identify
 * Results**: At least 1 screening criterion was identified in 1527 (40.8%) of 3745 charts. The physician reviewers identified AEs in 255 of the charts. After adjustment for the sampling strategy, the AE rate was 7.5 per 100 hospital admissions (95% confidence interval [CI] 5.7–9.3). Among the patients with AEs, events judged to be preventable occurred in 36.9% (95% CI 32.0%–41.8%) and death in 20.8% (95% CI 7.8%–33.8%). Physician reviewers estimated that 1521 additional hospital days were associated with AEs. Although men and women experienced equal rates of AEs, patients who had AEs were significantly older than those who did not (mean age [and standard deviation] 64.9 [16.7] v. 62.0 [18.4] years; p = 0.016).
 * Interpretation**: The overall incidence rate of AEs of 7.5% in our study suggests that, of the almost 2.5 million annual hospital admissions in Canada similar to the type studied, about 185 000 are associated with an AE and close to 70 000 of these are potentially preventable.

=United Kingdom=

[|Adverse events in British hospitals: preliminary retrospective record review] (PDF) British Medical Journal Abstract:
 * Authors**: Charles Vincent, Graham Neale, Maria Woloshynowych
 * Objectives** To examine the feasibility of detecting adverse events through record review in British hospitals and to make preliminary estimates of the incidence and costs of adverse events.
 * Design** Retrospective review of 1014 medical and nursing records.
 * Setting** Two acute hospitals in Greater London area.
 * Main outcome measure** Number of adverse events.
 * Results** 110 (10.8%) patients experienced an adverse event, with an overall rate of adverse events of 11.7% when multiple adverse events were included. About half of these events were judged preventable with ordinary standards of care. A third of adverse events led to moderate or greater disability or death.
 * Conclusions** These results suggest that adverse events are a serious source of harm to patients and a large drain on NHS resources. Some are major events; others are frequent, minor events that go unnoticed in routine clinical care but together have massive economic consequences.

=United States=

[|Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study] - New England Journal of Medicine Abstract:
 * Authors**: TA Brennan, LL Leape, NM Laird, L Herbert, AR Localio, AG Lawthers, JP Newhouse, PC Weiler, and HH Hiatt
 * BACKGROUND**. As part of an interdisciplinary study of medical injury and malpractice litigation, we estimated the incidence of adverse events, defined as injuries caused by medical management, and of the subgroup of such injuries that resulted from negligent or substandard care. **METHODS**. We reviewed 30,121 randomly selected records from 51 randomly selected acute care, nonpsychiatric hospitals in New York State in 1984. We then developed population estimates of injuries and computed rates according to the age and sex of the patients as well as the specialties of the physicians.
 * RESULTS**. Adverse events occurred in 3.7 percent of the hospitalizations (95 percent confidence interval, 3.2 to 4.2), and 27.6 percent of the adverse events were due to negligence (95 percent confidence interval, 22.5 to 32.6). Although 70.5 percent of the adverse events gave rise to disability lasting less than six months, 2.6 percent caused permanently disabling injuries and 13.6 percent led to death. The percentage of adverse events attributable to negligence increased in the categories of more severe injuries (Wald test chi 2 = 21.04, P less than 0.0001). Using weighted totals, we estimated that among the 2,671,863 patients discharged from New York hospitals in 1984 there were 98,609 adverse events and 27,179 adverse events involving negligence. Rates of adverse events rose with age (P less than 0.0001). The percentage of adverse events due to negligence was markedly higher among the elderly (P less than 0.01). There were significant differences in rates of adverse events among categories of clinical specialties (P less than 0.0001), but no differences in the percentage due to negligence.
 * CONCLUSIONS**. There is a substantial amount of injury to patients from medical management, and many injuries are the result of substandard care.