PMID- 12486985
OWN - NLM
STAT- MEDLINE
DCOM- 20030110
LR  - 20191210
IS  - 1475-3898 (Print)
IS  - 1475-3901 (Electronic)
IS  - 1475-3898 (Linking)
VI  - 11
IP  - 3
DP  - 2002 Sep
TI  - Setting priorities for patient safety.
PG  - 224-9
AB  - BACKGROUND: Current "flags" for adverse events (AEs) are biased towards those 
      with serious outcomes, potentially leading to failure to address mundane common 
      problems. AIM: To provide a basis for setting priorities to improve patient 
      safety by ranking adverse events by resource consumption as well as by outcome. 
      This was done by classifying a set of AEs, according to how they may be 
      prevented, into "Principal Natural Categories" (PNCs). SETTING: AEs associated 
      with a representative sample of admissions to Australian acute care hospitals. 
      DESIGN: AEs were classified into PNCs which were ranked by overall frequency, an 
      index of resource consumption (a function of mean extended hospital stay and the 
      number of cases in each PNC), and severity of outcome. RESULTS: The 1712 AEs 
      analysed fell into 581 PNCs; only 28% had more than two cases. Most resource use 
      (60%) was by AEs which led to minor disabilities, 36% was by those which led to 
      major disabilities, and 4% by those associated with death. Most of the events 
      with serious outcomes fell into fewer than 50 PNCs; only seven of these PNCs had 
      more than six cases resulting in serious outcomes. CONCLUSIONS: If interventions 
      for AEs are triggered only by serious outcomes by, for example, using recommended 
      risk scoring methods, most problems would not be addressed, particularly the 
      large number of mundane problems which consume the majority of resources. Both 
      serious and mundane problems should be addressed. Most types of events occur too 
      infrequently to be characterised at a hospital level and require large scale 
      (preferably national) collections of incidents and events.
FAU - Runciman, W B
AU  - Runciman WB
AD  - Department of Anaesthesia and Intensive Care, Royal Adelaide Hospital, University 
      of Adelaide, Adelaide, South Australia. wrunciman@bigpond.com
FAU - Edmonds, M J
AU  - Edmonds MJ
FAU - Pradhan, M
AU  - Pradhan M
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Qual Saf Health Care
JT  - Quality & safety in health care
JID - 101136980
MH  - Australia/epidemiology
MH  - Health Care Rationing
MH  - *Health Priorities
MH  - Hospital Administration/*standards
MH  - Hospital Mortality
MH  - Humans
MH  - Iatrogenic Disease/epidemiology/prevention & control
MH  - Medical Errors/*classification/*prevention & control
MH  - Outcome Assessment, Health Care
MH  - Quality Assurance, Health Care
MH  - Risk Assessment
MH  - Safety Management/*organization & administration
PMC - PMC1743639
EDAT- 2002/12/19 04:00
MHDA- 2003/01/11 04:00
PMCR- 2005/09/01
CRDT- 2002/12/19 04:00
PHST- 2002/12/19 04:00 [pubmed]
PHST- 2003/01/11 04:00 [medline]
PHST- 2002/12/19 04:00 [entrez]
PHST- 2005/09/01 00:00 [pmc-release]
AID - 10.1136/qhc.11.3.224 [doi]
PST - ppublish
SO  - Qual Saf Health Care. 2002 Sep;11(3):224-9. doi: 10.1136/qhc.11.3.224.