Objective To systematically quantify the prevalence, severity, and nature of preventable patient harm across a range of medical settings globally. Design Systematic review and meta-analysis. Data sources Medline, PubMed, PsycINFO, Cinahl and Embase, WHOLIS, Google Scholar, and SIGLE from January 2000 to January 2019. The reference lists of eligible studies and other relevant systematic reviews were also searched. Review methods Observational studies reporting preventable patient harm in medical care. The core outcomes were the prevalence, severity, and types of preventable patient harm reported as percentages and their 95% confidence intervals. Data extraction and critical appraisal were undertaken by two reviewers working independently. Random effects meta-analysis was employed followed by univariable and multivariable meta regression. Heterogeneity was quantified by using the I2 statistic, and publication bias was evaluated. Results Of the 7313 records identified, 70 studies involving 337 025 patients were included in the meta-analysis. The pooled prevalence for preventable patient harm was 6% (95% confidence interval 5% to 7%). A pooled proportion of 12% (9% to 15%) of preventable patient harm was severe or led to death. Incidents related to drugs (25%, 95% confidence interval 16% to 34%) and other treatments (24%, 21% to 30%) accounted for the largest proportion of preventable patient harm. Compared with general hospitals (where most evidence originated), preventable patient harm was more prevalent in advanced specialties (intensive care or surgery; regression coefficient b=0.07, 95% confidence interval 0.04 to 0.10). Conclusions Around one in 20 patients are exposed to preventable harm in medical care. Although a focus on preventable patient harm has been encouraged by the international patient safety policy agenda, there are limited quality improvement practices specifically targeting incidents of preventable patient harm rather than overall patient harm (preventable and non-preventable). Developing and implementing evidence-based mitigation strategies specifically targeting preventable patient harm could lead to major service quality improvements in medical care which could also be more cost effective.

https://www.bmj.com/content/bmj/366/bmj.l4185.full.pdf

Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis

This study sought to evaluate the occurrence of adverse events and their impacts on length of stay and mortality in an intensive care unit (ICU). This is a prospective study carried out in a teaching hospital in Rio de Janeiro, Brazil. The cohort included 355 patients over 18 years of age admitted to the ICU between August 1, 2011 and July 31, 2012. The process we used to identify adverse events was adapted from the method proposed by the Institute for Healthcare Improvement. We used a logistical regression to analyze the association between adverse event occurrence and death, adjusted by case severity. We confirmed 324 adverse events in 115 patients admitted over the year we followed. The incidence rate was 9.3 adverse events per 100 patients-day and adverse event occurrence impacted on an increase in length of stay (19 days) and in mortality (OR = 2.047; 95%CI: 1.172-3.570). This study highlights the serious problem of adverse events in intensive care and the risk factors associated with adverse event incidence.

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Adverse events in the intensive care unit: impact on mortality and length of stay in a prospective study

Purpose We performed a systematic review to assess (i) to what extent incident reporting systems (IRSs) on the adult intensive care unit (ICU) meet the criteria of the WHO Draft Guidelines for Adverse Event Reporting and Learning Systems, (ii) to what extent the IRSs comply with the four aspects of the iterative quality loop and (iii) whether IRSs have led to improvement measures in clinical practice.

Data sources The authors searched multiple electronic databases from 1966 until 26 June 2014.

Study selection Studies were included if they reported incident reporting systems on the adult ICU.

Data extraction Data on study design, characteristics of the incident reporting system, implementation, feedback and improvement measures were collected using structured data extraction forms.

Results of data synthesis A total of 2098 studies were identified and 36 studies reported IRSs on the adult ICU. Studies were divided into: ICU-specific IRSs and general IRSs. Items of the WHO checklist were assessed and categorized into the four phases of the iterative quality loop.

Conclusion None of the IRSs completely fulfilled the WHO checklist criteria. With respect to the iterative loop, data input and data collection are well established but not much attention was given to analyzing incidents and to give feedback. This resulted in an administrative report system, rather than the much desired instrument for change of practice and increase of quality as an IRS can only effectively contribute to improve patient safety and quality of care if more attention is given to analyzing incidents and feedback.

/pdf/incident-and-error-reporting-systems-in-intensive-care-a-5ev63g0vrd.pdf

Incident and error reporting systems in intensive care: a systematic review of the literature

Adverse events and medical errors (AEs/MEs) are more likely to occur in the intensive care unit (ICU). Information about the incidence and outcomes of such events is conflicting. A systematic review and meta-analysis were conducted to examine the effects of MEs/AEs on mortality and hospital and ICU lengths of stay among ICU patients. Potentially eligible studies were identified from 4 major databases. Of 902 studies screened, 12 met the inclusion criteria, 10 of which are included in the quantitative analysis. Patients with 1 or more MEs/AEs (vs no MEs/AEs) had a nonsignificant increase in mortality (odds ratio = 1.5; 95% confidence interval [CI] = 0.98-2.14) but significantly longer hospital and ICU stays; the mean difference (95% CI) was 8.9 (3.3-14.7) days for hospital stay and 6.8 (0.2-13.4) days for ICU. The ICU environment is associated with a substantial incidence of MEs/AEs, and patients with MEs/AEs have worse outcomes than those with no MEs/AEs.

Outcome of Adverse Events and Medical Errors in the Intensive Care Unit: A Systematic Review and Meta-analysis

Intensive care nurses' perceptions of simulation-based team training for building patient safety in intensive care: A descriptive qualitative study

Objective To estimate the incidence and characteristics of adverse events (AEs) and no-harm events (NHEs) in critically ill patients.

Design Observational, prospective, 24-h cross-sectional study with self-reporting.

Setting Seventy-nine intensive care units at 76 hospitals.

Measurements Number of events, risk of AEs and NHEs, types of incidents, severity and avoidability of incidents.

Results A total of 1017 patients were included in the study; 591 (58%) were affected by one or more incidents. Of the 1424 valid incidents, 943 (66%) were NHEs and 481 (34%) were AEs. The individual risk of suffering at least one incident was 62%, at least one NHE 45% and at least one AE 29%. The median number of incidents, NHEs and AEs was 6, 3 and 2 per 100 patient-hours, respectively. Seventy-four per cent of the incidents were related to medication (24%), equipment (15%), nursing care (14%), accidental withdrawal of vascular accesses and catheters (10%) or airways and mechanical ventilation (10%). AEs resulted in temporary damage in 29% and in permanent damage or damage that compromised patients' lives or contributed to their death in 4%. Incidents were avoidable in 79% of cases (90% in NHEs and 60% in AEs, P < 0.05).

Conclusions The individual risk for incidents in critical patients is high. Many incidents did not harm patients, some caused damage and a few were related to the patient's death. Most incidents were considered avoidable.

Paz Merino

Papers

Adverse events in Spanish intensive care units: the SYREC study.

Safety incidents in airway and mechanical ventilation in Spanish ICUs: The IVeMVA study.