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Variability of adverse events in the public health-care service of the Tuscany region

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Abstract

The objective of the study is to analyze the variation of adverse events (AEs) according to the different structure of hospitals. The study is a multicenter, retrospective study. It involves 4 teaching hospitals (THs) and 32 community hospitals, distributed in 12 local trusts (LTs), of the Tuscany Regional Healthcare Service (RHS). A random sample of the clinical records of patients admitted in LTs and THs in 2008 was selected from the database of the hospital discharge records of the centers. Among 11,293 clinical records included, a total of 354 adverse events were identified. There was a significant higher incidence of AEs in the male and elderly (>65 years) population, and the incidence of AEs was more relevant in the THs (5.3, 95% CI 4.7–6.1) than in the LTs (1.8, 95% CI 1.5–2.2). AEs related to falls were significantly more preventable in THs (OR 19.22, 95% CI 2.45–151.02), while in LTs, AEs related to infections were the most preventable (OR 6.22, 95% CI 1.35–28.67). Concerning the consequence of AE, death is significantly more probable for AEs related to unexpected cardiac arrest in LTs, while disability and prolongation of the stay are significantly more probable consequences associated with re-admission in THs, and to transfer to ICU or HDU in LTs. Re-interventions, surgical complications and falls are the factors more correlated with AEs. In conclusion, the study shows a higher risk of incurring adverse events for the THs compared to the LTs, presumably connected with a major complexity of the clinical cases. Furthermore, the preventability of AEs is higher in the LTs (56.1 vs 42.2%), and this might be associated with lower expertise in managing complications in these settings. Concerning specialties, there are no significant differences in AEs distribution.

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Acknowledgements

Our acknowledgments for the collaboration to all the reviewers involved and to the clinical risk managers of the THs and LTs: Giuseppe Opizzi e Aldo Silvani (Azienda Ospedaliera Ospedale Niguarda Ca’Granda, Milano), Amalia Biasco, Silvana Cinalli, Luigi Pinnarelli, Maria Maddalena Sanna (Azienda Ospedaliera San Filippo Neri, Roma), Fiorenza Zotti, Maria Cassano, Sara Sblano, Lidia Dalfino (Policlinico di Bari), Alberto Farese, Elisabetta Magnelli, (AOU Careggi, Firenze), Annalaura Costa, Elena Belli, Francesca Battisti and Simona Frangioni (Azienda Ospedaliera Universitaria di Pisa).

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Authors and Affiliations

  1. Centre for Clinical Risk Management and Patient Safety, Tuscany Region, Villa La Quiete alle Montalve, Via Pietro Dazzi, 1, 50141, Florence, Italy

    Sara Albolino, Riccardo Tartaglia & Tommaso Bellandi

  2. Institute for Cancer Prevention, Florence, Italy

    Elisa Bianchini, Giancarlo Fabbro & Annibale Biggeri

  3. Regional Agency for Quality in Healthcare, Florence, Italy

    Silvia Forni

  4. Department of Medicine, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy

    Giulia Cernuschi

Authors
  1. Sara Albolino
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  2. Riccardo Tartaglia
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  3. Tommaso Bellandi
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  4. Elisa Bianchini
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  5. Giancarlo Fabbro
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  6. Silvia Forni
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  7. Giulia Cernuschi
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  8. Annibale Biggeri
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Corresponding author

Correspondence to Sara Albolino.

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Funding

This work was supported by the Ministry of Health with the national program PS 8 “Approcci di sistema per la gestione del rischio” CUP E35J09000030001.

Ethics approval

The authors sought ethics approval for the study to the Regional Research Ethic Review Board, but the Ethics Review Board determined that this study was exempt. Thus, according to the Italian legislation (law 211/2003) and the regional procedures, the Regional Research Ethic Review Board stated that the study do not need ethic approval as it attains to clinical research studies and does not provide statements on observational studies on routine collected, anonymous data. Data were extracted from routinely collected administrative databases and there was no need to obtain additional data from individual patients. The interventions under study were performed in ordinary conditions, irrespective of the conduct of the present study. Because this was an observational retrospective study, patients had already been treated when the study protocol was written. Data linkage to the patients was performed by using numerical codes, and researchers had access only to an anonymous dataset, which ensured patients’ privacy. For these reasons, no personal informed consent to the present analysis was requested from the study participants. The permission for medical record consultation was given by the Medical Directions of hospitals involved in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

No animal studies were conducted. We followed the Helsinki Declaration and its amendments and followed all standard national and international ethical standards.

Informed consent

No personal informed consent to the present analysis was requested from the study participants. The permission for medical records consultation was given by the Medical Directions of hospitals involved in the study.

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Albolino, S., Tartaglia, R., Bellandi, T. et al. Variability of adverse events in the public health-care service of the Tuscany region. Intern Emerg Med 12, 1033–1042 (2017). https://doi.org/10.1007/s11739-017-1698-5

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  • DOI: https://doi.org/10.1007/s11739-017-1698-5

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