Patient reports of undesirable events during hospitalization
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BACKGROUND: Thus far, incident reporting in health care has relied on health professionals. However, patients too may be able to signal the occurrence of undesirable events.
OBJECTIVE: To estimate the frequency of undesirable events reported by recently discharged patients, and to identify correlates of undesirable events.
DESIGN: Mailed patient survey.
SETTING: Swiss public teaching hospital.
PARTICIPANTS: Adult patients (N=1,518) discharged from hospital.
MEASUREMENTS: Self-reports of 27 undesirable events during hospitalization, including 9 medical complications, 9 interpersonal problems, and 9 incidents related to the health care process.
RESULTS: Most survey respondents (1,433, 94.4%) completed the section about undesirable events, and 725 (50.6%) reported at least 1 event. The most frequent events were phlebitis (11.0%), unavailable medical record (9.5%), failure to respect confidentiality (8.4%), and hospital-acquired infection (8.2%). The odds of an unfavorable rating increased with each additional interpersonal problem (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.3 to 1.8), each additional process-related problem (OR 1.5, 95% CI 1.3 to 1.9), but not with each additional medical complication (OR 1.0, 95% CI 0.9 to 1.2). Longer duration of stay, poor health, and depressed mood were all related to a greater reported frequency of undesirable events.
CONCLUSION: Patients are able to report undesirable events that occur during hospital care. Such events occur in about a half of the hospitalizations, and have a negative impact on satisfaction with care.
- Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991;324:370–6. CrossRef
- Leape LL, Brennan TA, Laird N. et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med. 1991;324:377–84. CrossRef
- Thomas EJ, Studdert DM, Burstin HR, et al. Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care. 2000;38:261–71. CrossRef
- Vincent C, Neale G, Woloshynowych M. Adverse events in British hospitals: preliminary retrospective record review. BMJ. 2001;322:517–9. CrossRef
- Leape LL, Berwick BM, Bates DW. What practices will most improve safety? Evidence-based medicine meets patient safety. JAMA. 2002;288:501–7. CrossRef
- Scott HD, Thacher-Renshaw A, Rosenbaum SE, et al. Physician reporting of adverse drug reactions. Results of the Rhode Island adverse drug reaction reporting project. JAMA. 1990;263:1785–8. CrossRef
- Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and potential adverse drug events. JAMA. 1995;274:29–34. CrossRef
- Runciman WB, Roughhead EE, Semple SJ, Adams RJ. Adverse drug events and medication errors in Australia. Int J Qual Health Care. 2003;15(suppl 1):149–59.
- Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European prevalence of infection in intensive care (EPIC) Study. JAMA. 1995;274:639–44. CrossRef
- Sax H, Hugonnet S, Harbarth S, Herrault P, Pittet D. Variation in nosocomial infection prevalence according to patient care setting: a hospital-wide survey. J Hosp Infect. 2001;48:27–32. CrossRef
- Perneger TV, Héliot C, Raë AC, Borst F, Gaspoz JM. Hospital-acquired pressure ulcers: risk factors and use of preventive devices. Arch Intern Med. 1998;158:1940–5. CrossRef
- Bours GJ, Halfens RJ, Candel MJ, Grol RT, Abu-Saad HH. Pressure ulcer audit and feedback project across multi-hospital settings in the Netherlands. Int J Qual Health Care. 2004;16:211–8. CrossRef
- Gawande AA, Studdert DM, Orav EJ, Brennan TA, Zinner MJ. Risk factors for retained instruments and sponges after surgery. N Engl J Med. 2003;348:229–35. CrossRef
- Runciman WB, Sellen A, Webb RK, et al. The Australian incident monitoring study. Errors, incidents and accidents in anaesthetic practice. Anaesth Intens Care. 1993;21:506–19.
- Witham MD, Kendall PA. A prospective, physician self-reported adverse incident audit on a general medical unit. J Qual Clin Pract. 2001;21:61–5. CrossRef
- Welsh CH, Pedot R, Anderson RJ. Use of morning report to enhance adverse event detection. J Gen Intern Med. 1996;11:454–60. CrossRef
- Weingart SN, Callanan LD, Ship AN, Aronson MD. A physician-based voluntary reporting system for adverse events and medical errors. J Gen Intern Med. 2001;16:809–14. CrossRef
- Thomas EJ, Petersen LA. Measuring errors and adverse events in health care. J Gen Intern Med. 2003;18:61–7. CrossRef
- Murff HJ, Patel VL, Hripcsak G, Bates DW. Detecting adverse events for patient safety research: a review of current methodologies. J Biomed Inform. 2003;36:131–43. CrossRef
- Michel P, Quenon JL, de Sarasqueta AM, Scemama O. Comparison of three methods for estimating rates of adverse events and rates of preventable adverse events in acute care hospitals. BMJ. 2004;328:199–202. CrossRef
- Waring JJ. A qualitative study of the intra-hospital variations in incident reporting. Int J Qual Health Care. 2004;16:347–52. CrossRef
- Cleary PD, Edgman-Levitan S. Health care quality. Incorporating consumer perspectives. JAMA. 1997;278:1608–12. CrossRef
- Vincent CA, Coulter A. Patient safety: what about the patient? Qual Saf Health Care. 2002;11:76–80. CrossRef
- van den Bemt PM, Egberts AC, Lenderink AW, et al. Adverse drug events in hospitalized patients. A comparison of doctors, nurses and patients as sources of reports. Eur J Clin Pharmacol. 1999;55:155–8. CrossRef
- Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138:161–7.
- Bovier PA, Charvet A, Cleopas A, Vogt N, Perneger TV. Self-reported management of pain in hospitalized patients: link between process and outcome. Am J Med. 2004;117:569–74. CrossRef
- Perneger TV, Chamot A, Bovier PA. Non-response bias in a survey of patient perceptions of hospital care. Med Care. 2005;43:374–80. CrossRef
- Cleary PD, Edgman-Levitan S, Roberts M, et al. Patients evaluate their hospital care: a national survey. Health Aff (Milwood). 1991;10:254–67. CrossRef
- Jenkinson C, Coulter A, Bruster S. The picker patient experience questionnaire: development and validation using data from in-patient surveys in five countries. Int J Qual Health Care. 2002;14:353–8. CrossRef
- Perneger TV, Kossovsky MP, Cathieni F, di Florio V, Burnand B. A randomized trial of four patient satisfaction questionnaires. Med Care. 2003;41:1343–52. CrossRef
- Jenkinson C, Stewart-Brown S, Petersen S, Paice C. Assessment of the SF-36 version 2 in the United Kingdom. J Epidemiol Community Health. 1999;53:46–50. CrossRef
- Leplège A, Ecosse E, Verdier A, Perneger TV. The French SF-36 health survey: translation, cultural adaptation, and preliminary psychometric evaluation. J Clin Epidemiol. 1998;51:1013–23. CrossRef
- Andrews LB, Stocking C, Krizek T, et al. An alternative strategy for studying adverse events in medical care. Lancet. 1997;349:309–13. CrossRef
- Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. 1998;279:1200–5. CrossRef
- Jenkinson C, Coulter A, Bruster S, Richards N, Chandola T. Patients’ experiences and satisfaction with health care: results of a questionnaire study of specific aspects of care. Qual Saf Health Care. 2002;11:335–9. CrossRef
- Escher M, Perneger TV, Chevrolet JC. National questionnaire survey on what influences doctors’ decisions about admission to intensive care. BMJ. 2004;329:425–9. CrossRef
- Cleary PD, Lubalin J, Hays RD, Short PF, Edgman-Levitan S, Sheridan S. Debating survey approaches (letter). Health Aff (Milwood). 1998;17:265–6. CrossRef
- Allen HM, Rogers WH. Debating survey approaches: the authors respond (letter). Health Aff (Milwood). 1998;17:266–8.
- Perneger TV. Adjustment for patient characteristics in satisfaction surveys. Int J Qual Health Care. 2004;16:433–5. CrossRef
- Patient reports of undesirable events during hospitalization
Journal of General Internal Medicine
Volume 20, Issue 10 , pp 922-928
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- patient safety
- patient satisfaction
- Industry Sectors
- Author Affiliations
- 1. Quality of Care Service, Geneva University Hospitals, CH-1211, Geneva 14, Switzerland
- 2. Department of Community Medicine, Geneva University Hospitals, Geneva, Switzerland
- 3. Institute of Social and Preventive Medicine, University of Geneva, Geneva, Switzerland