Incidence and Types of Adverse Events and Negligent Care in Utah and Colorado

Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Medical Care (Impact Factor: 3.23). 03/2000; 38(3):261-71. DOI: 10.1097/00005650-200003000-00003
Source: PubMed


The ongoing debate on the incidence and types of iatrogenic injuries in American hospitals has been informed primarily by the Harvard Medical Practice Study, which analyzed hospitalizations in New York in 1984. The generalizability of these findings is unknown and has been questioned by other studies.
We used methods similar to the Harvard Medical Practice Study to estimate the incidence and types of adverse events and negligent adverse events in Utah and Colorado in 1992.
We selected a representative sample of hospitals from Utah and Colorado and then randomly sampled 15,000 nonpsychiatric 1992 discharges. Each record was screened by a trained nurse-reviewer for 1 of 18 criteria associated with adverse events. If > or =1 criteria were present, the record was reviewed by a trained physician to determine whether an adverse event or negligent adverse event occurred and to classify the type of adverse event.
The measures were adverse events and negligent adverse events.
Adverse events occurred in 2.9+/-0.2% (mean+/-SD) of hospitalizations in each state. In Utah, 32.6+/-4% of adverse events were due to negligence; in Colorado, 27.4+/-2.4%. Death occurred in 6.6+/-1.2% of adverse events and 8.8+/-2.5% of negligent adverse events. Operative adverse events comprised 44.9% of all adverse events; 16.9% were negligent, and 16.6% resulted in permanent disability. Adverse drug events were the leading cause of nonoperative adverse events (19.3% of all adverse events; 35.1% were negligent, and 9.7% caused permanent disability). Most adverse events were attributed to surgeons (46.1%, 22.3% negligent) and internists (23.2%, 44.9% negligent).
The incidence and types of adverse events in Utah and Colorado in 1992 were similar to those in New York State in 1984. Iatrogenic injury continues to be a significant public health problem. Improving systems of surgical care and drug delivery could substantially reduce the burden of iatrogenic injury.

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    • "Communication breakdown, as a form of conflict involving surgeons in the OT, is suggested to be common (Rogers & Lingard, 2006) and has been attributed to being the ''primary behaviour'' that increases risk of surgical mishap or mistakes with surgical patients (Lingard, Garwood, et al., 2004; Sexton, Thomas, & Helmreich, 2000). Reinforcing this, research has suggested that surgical care is associated with one-half to two-thirds of adverse events in hospitals (Thomas et al., 2000). Given the potential complications of conflict and communication challenges in the OT, interprofessional practice is emerging in surgical training as having the potential to improve patient outcomes, in addition to increasing satisfaction in the work environment (Bleakley, Boyden, Hobbs, Walsh, & Allard, 2006; Reeves et al., 2008). "

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    • "Third, a review of the medical records begins on day 30 of the study using detection and confirmation questionnaires [2]. Major studies that have used this method include the Harvard Medical Practice Study [5] and the Study on Adverse Events and Negligent Care in Utah and Colorado [6]. According to the findings of these studies, the incidence of patient adverse events occurring in acute care hospitals in Utah and Colorado were 2.9% and 3.7% in New York [5,6]. "
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    ABSTRACT: Objectives: To evaluate the occurrence of patient adverse events in Korean hospitals as perceived by nurses and examine the correlation between patient adverse events with the nurse practice environment at nurse and hospital level. Methods: In total, 3096 nurses working in 60 general inpatient hospital units were included. A two-level logistic regression analysis was performed. Results: At the hospital level, patient adverse events included patient falls (60.5%), nosocomial infections (51.7%), pressure sores (42.6%) and medication errors (33.3%). Among the hospital-level explanatory variables associated with the nursing practice environment, ‘physician- nurse relationship’ correlated with medication errors while ‘education for improving quality of care’ affected patient falls. Conclusions: The doctor-nurse relationship and access to education that can improve the quality of care at the hospital level may help decrease the occurrence of patient adverse events.
    Journal of Preventive Medicine and Public Health 09/2014; 47(5):273-80. DOI:10.3961/jpmph.14.019
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    • "Since the 1970’s, epidemiological studies highlighted high rates of AEs experienced during hospital stay, ranging from 3.7% up to 36% [1, 10, 11]. Over the past 20 years, several studies, some of which nationwide, based on hospital records retrospective reviews, conducted in the USA [1, 5], Canada [12, 13], South America [14], Great Britain [6], Denmark [15], France [4], Germany [16, 17], Spain [18, 19], Sweden [20], Australia [21] and New Zealand [22, 23] have shown that the chance of a patient to experience an AE during hospitalization is still too high, ranging between 2.9% and 17%. Furthermore, it was noted that approximately half of the AEs were preventable [3, 16, 17]. "
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    ABSTRACT: The promotion of safer healthcare interventions in hospitals is a relevant public health topic. This study is aimed to investigate predictors of Adverse Events (AEs) taking into consideration the Charlson Index in order to control for confounding biases related to comorbidity. The study was a retrospective cohort study based on a two-stage assessment tool which was used to identify AEs. In stage 1, two physicians reviewed a random sample of patient records from 2008 discharges. In stage 2, reviewers independently assessed each screened record to confirm the presence of AEs. A univariable and multivariable analysis was conducted to identify prognostic factors of AEs; socio-demographic and some main organizational variables were taken into consideration. Charlson comorbidity Index was calculated using the algorithm developed by Quan et al. A total of 1501 records were reviewed; mean patients age was 60 (SD: 19) and 1415 (94.3%) patients were Italian. Forty-six (3.3%) AEs were registered; they most took place in medical wards (33, 71.7%), followed by surgical ones (9, 19.6%) and intensive care unit (ICU) (4, 8.7%). According to the logistic regression model and controlling for Charlson Index, the following variables were associated to AEs: type of admission (emergency vs elective: OR 3.47, 95% CI: 1.60-7.53), discharge ward (surgical and ICU vs medical wards: OR 2.29, 95% CI: 1.00-5.21 and OR 4.80, 95% CI: 1.47-15.66 respectively) and length of stay (OR 1.03, 95% CI 1.01-1.04). Among patients experiencing AEs a higher frequency of elderly (≥65 years) was shown (58.7% vs 49.3% among patients without AEs) but this difference was not statistically significant. Interestingly, a higher percentage of patients admitted through emergency department was found among patients experiencing AEs (69.7% vs 55.1% among patients without AEs). The incidence of AEs was associated with length of stay, type of admission and unit of discharge, independently by comorbidity. On the basis of our results, it appears that organizational characteristics, taking into account the adjustment for comorbidity, are the main factors responsible for AEs while patient vulnerability played a minor role.
    BMC Health Services Research 08/2014; 14(1):358. DOI:10.1186/1472-6963-14-358 · 1.71 Impact Factor
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