AN ALTERNATIVE STRATEGY FOR STUDYING ADVERSE EVENTS IN MEDICAL-CARE

Background Data about the frequency of adverse events related to inapp ropriate care in hospitals come from studies of medical records as if they represented a true record of adverse events. In a prospective, ob servational design we analysed discussion of adverse events during the care of all patients admitted to three units of a large, urban teachi ng hospital affiliated to a university medical school. Discussion took place during routine clinical meetings. We undertook the study to enh ance understanding of the incidence and scope of adverse events as a b asis for preventing them. Methods Ethnographers trained in qualitative observational research attended day-shift, weekday, regularly schedul ed attending rounds, residents' work rounds, nursing shift changes, ca se conferences, and other scheduled meetings in three study units as w ell as various departmental and section meetings. They recorded all ad verse events during patient care discussed at these meetings and devel oped a classification scheme to code the data. Data were collected abo ut health-care providers' own assessments about the appropriateness of the care that patients received to assess the nature and impact of ad verse events and how health-care providers and patients responded to t he adverse events. Findings Of the 1047 patients in the study, 185 (17 .7%) were said to have had at least one serious adverse event; having an initial event was linked to the seriousness of the patient's underl ying illness. Patients with long slays in hospital had more adverse ev ents than those with short stays. The likelihood of experiencing an ad verse event increased about 6% for each day of hospital stay. 37.8% of adverse events were caused by an individual, 15.6% had interactive ca uses, and 9.8% were due to administrative decisions. Although 17.7% of patients experienced serious events that led to longer hospital stays and increased costs to the patients, only 1.2% (13) of the 1047 patie nts made claims for compensation. Interpretation This study shows that there is a wide range of potential causes of adverse events that shou ld be considered, and that careful attention must be paid to errors wi th interactive or administrative causes. Healthcare providers' own dis cussions of adverse events can be a good source of data for proactive error prevention.