Adverse Events Rates in Hospitals and Hospital Departments
Adverse Events Rates in Hospitals and Hospital Departments
Objective. The objective of this study was to analyze the variation in the rates of adverse events (AEs), and preventable AEs, between hospitals and hospital departments in order to investigate the room for improvement in reducing AEs at both levels. In addition, we explored the extent to which patient, department and hospital characteristics explain differences in the rates of AEs.
Design. Structured retrospective patient record review of hospital admissions.
Setting. Twenty-one Dutch hospitals.
Population. A representative random sample of 7113 hospital admissions in 2004.
Main outcome measures. Variation in AEs, and preventable AEs, between hospitals and hospital departments and the explanatory factors of the variation.
Results. The rates of AEs varied between hospitals (P = 0.05) and hospital departments (P < 0.05). The rates of preventable AEs only varied significantly between hospital departments. The clustering of preventable AEs in hospital departments was more than twice that found in hospitals (ICC 9.5 versus 3.5%). The type of hospital explained 35% of the inter-hospital variance in AEs. Patient and department characteristics explained 23% of the inter-department variance in preventable AEs.
Conclusions. In addition to interventions to improve the overall patient safety within a hospital, interventions tailored for specific departments are necessary to reduce their patient safety risks. Monitoring and comparing the performance of hospitals should not be limited to the hospital level, but should be extended to the individual department since there can be significant differences in the rates of preventable AEs between different departments within the same hospital.
Patient record review studies have shown that a substantial number of patients in acute care hospitals experience adverse events (AEs) and that part of the AEs contributed to the patient's death. Approximately half of the AEs were judged to be preventable. Based on these findings, patient safety programs have been initiated to reduce the amount of AEs.
There is a growing interest in measuring the variation in the quality of health care between healthcare institutions. Comparative measures of mortality and morbidity are used by healthcare professionals to improve care, by patients to select their caregiver, by insurers to contract doctors and hospitals and by hospital managers and policy makers to monitor the quality of care. Hospital care is organized at different levels and it is argued that the incidence rates of AEs differ more between hospital departments than between hospitals. Hospital departments are specialist units, such as cardiology, intensive care and neurology, and vary widely in the services they offer. Moreover, the study of Smits et al. showed that the patient safety culture among hospital employees varies more between hospital departments than between hospitals. There is limited information about the extent of variation in the incidence rate of AEs between hospitals and between hospital departments. This limits insight into the room for improvement at the hospital, and hospital department, levels.
Between August 2005 and October 2006, a patient record review study was carried out to assess the national incidence of AEs in Dutch hospitals. The study showed that in 5.7% [95% confidence interval (CI): 5.1–6.4] of the hospital admissions one or more AEs were found and that in 2.3% (95% CI: 1.9–2.7) one or more preventable AEs were detected.
In this article, we used multilevel analysis to examine the variation in the overall rates of AEs, and rates of preventable AEs, between hospitals and between hospital departments. We also examined the influence of patient mix, department characteristics and the type of hospital on the variation in the rates of AEs and preventable AEs. The composition of patients differs between hospitals and hospital departments. For example, complex patients are often referred to university hospitals and patients admitted to surgical departments are at higher risk of suffering from AEs. To attribute the variation in the rates of AEs to hospitals and hospital departments, sufficient correction for patient mix and structural factors, such as hospital type and type of department, is required. The remaining variance after correction gives an indication of the room for improvement at both levels.
The research questions of this study are given below.
Abstract and Introduction
Abstract
Objective. The objective of this study was to analyze the variation in the rates of adverse events (AEs), and preventable AEs, between hospitals and hospital departments in order to investigate the room for improvement in reducing AEs at both levels. In addition, we explored the extent to which patient, department and hospital characteristics explain differences in the rates of AEs.
Design. Structured retrospective patient record review of hospital admissions.
Setting. Twenty-one Dutch hospitals.
Population. A representative random sample of 7113 hospital admissions in 2004.
Main outcome measures. Variation in AEs, and preventable AEs, between hospitals and hospital departments and the explanatory factors of the variation.
Results. The rates of AEs varied between hospitals (P = 0.05) and hospital departments (P < 0.05). The rates of preventable AEs only varied significantly between hospital departments. The clustering of preventable AEs in hospital departments was more than twice that found in hospitals (ICC 9.5 versus 3.5%). The type of hospital explained 35% of the inter-hospital variance in AEs. Patient and department characteristics explained 23% of the inter-department variance in preventable AEs.
Conclusions. In addition to interventions to improve the overall patient safety within a hospital, interventions tailored for specific departments are necessary to reduce their patient safety risks. Monitoring and comparing the performance of hospitals should not be limited to the hospital level, but should be extended to the individual department since there can be significant differences in the rates of preventable AEs between different departments within the same hospital.
Introduction
Patient record review studies have shown that a substantial number of patients in acute care hospitals experience adverse events (AEs) and that part of the AEs contributed to the patient's death. Approximately half of the AEs were judged to be preventable. Based on these findings, patient safety programs have been initiated to reduce the amount of AEs.
There is a growing interest in measuring the variation in the quality of health care between healthcare institutions. Comparative measures of mortality and morbidity are used by healthcare professionals to improve care, by patients to select their caregiver, by insurers to contract doctors and hospitals and by hospital managers and policy makers to monitor the quality of care. Hospital care is organized at different levels and it is argued that the incidence rates of AEs differ more between hospital departments than between hospitals. Hospital departments are specialist units, such as cardiology, intensive care and neurology, and vary widely in the services they offer. Moreover, the study of Smits et al. showed that the patient safety culture among hospital employees varies more between hospital departments than between hospitals. There is limited information about the extent of variation in the incidence rate of AEs between hospitals and between hospital departments. This limits insight into the room for improvement at the hospital, and hospital department, levels.
Between August 2005 and October 2006, a patient record review study was carried out to assess the national incidence of AEs in Dutch hospitals. The study showed that in 5.7% [95% confidence interval (CI): 5.1–6.4] of the hospital admissions one or more AEs were found and that in 2.3% (95% CI: 1.9–2.7) one or more preventable AEs were detected.
In this article, we used multilevel analysis to examine the variation in the overall rates of AEs, and rates of preventable AEs, between hospitals and between hospital departments. We also examined the influence of patient mix, department characteristics and the type of hospital on the variation in the rates of AEs and preventable AEs. The composition of patients differs between hospitals and hospital departments. For example, complex patients are often referred to university hospitals and patients admitted to surgical departments are at higher risk of suffering from AEs. To attribute the variation in the rates of AEs to hospitals and hospital departments, sufficient correction for patient mix and structural factors, such as hospital type and type of department, is required. The remaining variance after correction gives an indication of the room for improvement at both levels.
The research questions of this study are given below.
To what extent do the rates of AEs, and the rates of preventable AEs, vary between hospitals and between hospital departments?
To what extent is the variation in AEs, and preventable AEs, between hospitals, and between hospital departments, a result of differences in the composition of the patient population, type of department and hospital type?