To assess the occurrence, impact and preventability of adverse events recorded in New Zealand public hospitals.
A two-stage retrospective review was carried out on 6,579 medical records. These were selected by systematic list sample from admissions for 1998 occurring in 13 public hospitals throughout New Zealand providing acute care and with over 100 beds, excluding specialist institutions. Following initial screening, medical records were subject to structured implicit review (that is, the guided exercise of professional judgement) by a team of trained medical officers using a standardised protocol.
The information available in the sampled medical records was of a quality that permitted the adequate identification and analysis of adverse events. The processes and instruments used in comparator studies internationally were applied in the New Zealand setting with little difficulty. Reliability and validity measures displayed only moderate levels of agreement, however. Analysis of the 850 adverse events identified revealed a distribution, impact, and clinical context comparable with other studies. Adverse events (which may have occurred either within or outside public hospitals) were associated with 12.9 percent of admissions. Approximately 35 percent of adverse events were classified as highly preventable. Although less than 15 percent of adverse events resulted in permanent disability or death, an average of over nine days per event was added to hospital stay. Nearly a fifth of events originated from outside public hospitals, only a quarter of which arose in another institutional context. Patient age was an important risk factor for an adverse event. There were distinct patterns according to clinical and administrative context. Systems errors featured prominently in the analysis of areas for the prevention of recurrence.
The study provides the base parameters necessary to inform our understanding of patient safety and the quality of care in New Zealand public hospitals. These data have important managerial and clinical implications. Further work could be done on sub-groups of patients and on the clinical detail available in the data. The investigation provides a baseline for more targeted studies and for quality improvement interventions. It also points to the importance of similar research on the sources and characteristics of adverse events outside public hospitals.