Ottawa Hospital Patient Safety Study: incidence and timing of adverse events in patients admitted to a Canadian teaching hospital.
BACKGROUND
Adverse events are poor patient outcomes that are due to medical care. Studies of hospital patients have demonstrated that adverse events are common, but few data describe the timing of them in relation to hospital admission. We evaluated characteristics of adverse events affecting patients admitted to a Canadian teaching hospital, paying particular attention to timing.


METHODS
We randomly selected 502 adults admitted to the Ottawa Hospital for acute care of nonpsychiatric illnesses over a 1-year period. Charts were reviewed in 2 stages. If an adverse event was judged to have occurred, a physician determined whether it occurred before or during the index hospitalization. The reviewer also rated the preventability, severity and type of each adverse event.


RESULTS
Of the 64 patients with an adverse event (incidence 12.7%, 95% confidence interval [CI] 10.1%-16.0%), 24 had a preventable event (4.8%, 95% CI 3.2%-7.0%), and 3 (0.6%, 95% CI 0.2%-1.7%) died because of an adverse event. Most adverse events were due to drug treatment, operative complications or nosocomial infections. Of the 64 patients, 39 (61%, 95% CI 49%-72%) experienced the adverse event before the index hospitalization.


CONCLUSIONS
Adverse events were common in this study. However, only one-third were deemed avoidable, and most occurred before the hospitalization. Interventions to improve safety must address ambulatory care as well as hospital-based care.
Forster
Alan J
AJ
Ottawa Health Research Institute, Ottawa, Ont. aforster@ohri.ca
Asmis
Tim R
TR
Clark
Heather D
HD
Al Saied
Ghiath
G
Code
Catherine C
CC
Caughey
Sharon C
SC
Baker
Kevin
K
Watters
James
J
Worthington
Jim
J
van Walraven
Carl
C
D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000592:standards; D006784:Hospitals, Teaching / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D015994:Incidence; D019300:Medical Errors / Q000706:statistics & numerical data; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D017751:Safety Management / Q000592:standards / Q000706:statistics & numerical data*; D013997:Time Factors