French national survey of inpatient adverse events prospectively assessed with ward staff.
OBJECTIVE
To estimate the incidence of adverse events in medical and surgical activity in public and private hospitals, and to assess the clinical situation of patients and the active errors.


METHODS
Prospective assessment of adverse events by external senior nursing and doctor investigators with ward staff.


METHODS
Random three-stage stratified cluster sampling of stays or fractions of stay in a 7-day observation period for each ward.


METHODS
8754 patients observed in 292 wards in 71 hospitals, over 35,234 hospitalisation days.


METHODS
Number of adverse events in relation to number of days of hospitalisation.


RESULTS
The incidence density of adverse events was 6.6 per 1000 days of hospitalisation (95% CI 5.7 to 7.5), of which 35% were preventable. Invasive procedures were the source of half the adverse events, of which 20% were preventable. Adverse events related to the psychological sphere and pain were mostly considered as preventable. Ward staff found it difficult to assess the role of care management in the occurrence of adverse events: 41% of adverse events were expected because of the disease itself, and could have occurred in the absence of the related medical management.


CONCLUSIONS
At the national level in France, every year 120,000-190,000 adverse events during hospitalisation can be considered as preventable. Areas such as perioperative period and geriatric units should receive closer attention. As adverse events occurred more commonly in vulnerable patients, who are not specifically targeted by clinical guidance, practising evidence-based medicine is not likely to prevent all cases. Therefore clinical risk management should prioritize empowerment of local staff, provision of favourable conditions within the organisation, and staff training based on simple tools appropriate for ward-level identification and analysis of adverse events.
Michel
Philippe
P
Comité de Coordination de l'Evaluation Clinique et de la Qualité en Aquitaine, Hôpital Xavier Arnozan, Pessac, France. philippe.michel@ccecqa.asso.fr
Quenon
Jean Luc
JL
Djihoud
Ahmed
A
Tricaud-Vialle
Sophie
S
de Sarasqueta
Anne Marie
AM
D005602:France / Q000453:epidemiology; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D015994:Incidence; D007362:Intensive Care Units / Q000592:standards* / Q000706:statistics & numerical data; D008485:Medical Audit; D008505:Medical Staff, Hospital; D008508:Medication Errors / Q000706:statistics & numerical data*; D008510:Medication Systems, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D009731:Nursing Audit; D009741:Nursing Staff, Hospital; D011446:Prospective Studies; D012189:Retrospective Studies; D012308:Risk Management; D018571:Sentinel Surveillance; D011795:Surveys and Questionnaires