PMID- 21367769
OWN - NLM
STAT- MEDLINE
DCOM- 20120111
LR  - 20211020
IS  - 2044-5423 (Electronic)
IS  - 2044-5415 (Print)
IS  - 2044-5415 (Linking)
VI  - 20
IP  - 9
DP  - 2011 Sep
TI  - Using prospective clinical surveillance to identify adverse events in hospital.
PG  - 756-63
LID - 10.1136/bmjqs.2010.048694 [doi]
AB  - 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.
FAU - Forster, Alan J
AU  - Forster AJ
AD  - The Ottawa Hospital, ON, Canada. aforster@ohri.ca
FAU - Worthington, Jim R
AU  - Worthington JR
FAU - Hawken, Steven
AU  - Hawken S
FAU - Bourke, Michael
AU  - Bourke M
FAU - Rubens, Fraser
AU  - Rubens F
FAU - Shojania, Kaveh
AU  - Shojania K
FAU - van Walraven, Carl
AU  - van Walraven C
LA  - eng
GR  - Canadian Institutes of Health Research/Canada
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20110301
PL  - England
TA  - BMJ Qual Saf
JT  - BMJ quality & safety
JID - 101546984
MH  - *Academic Medical Centers
MH  - Female
MH  - Humans
MH  - Interdisciplinary Communication
MH  - Male
MH  - Ontario
MH  - Peer Review
MH  - Prospective Studies
MH  - Risk Management/*methods
MH  - Safety Management
MH  - *Sentinel Surveillance
PMC - PMC3161499
COIS- Competing interests: None.
EDAT- 2011/03/04 06:00
MHDA- 2012/01/12 06:00
PMCR- 2011/03/01
CRDT- 2011/03/04 06:00
PHST- 2011/03/04 06:00 [entrez]
PHST- 2011/03/04 06:00 [pubmed]
PHST- 2012/01/12 06:00 [medline]
PHST- 2011/03/01 00:00 [pmc-release]
AID - bmjqs.2010.048694 [pii]
AID - qhc48694 [pii]
AID - 10.1136/bmjqs.2010.048694 [doi]
PST - ppublish
SO  - BMJ Qual Saf. 2011 Sep;20(9):756-63. doi: 10.1136/bmjqs.2010.048694. Epub 2011 
      Mar 1.