The incidence and nature of in-hospital adverse events: a systematic review.
BACKGROUND
Adverse events in hospitals constitute a serious problem with grave consequences. Many studies have been conducted to gain an insight into this problem, but a general overview of the data is lacking. We performed a systematic review of the literature on in-hospital adverse events.


METHODS
A formal search of Embase, Cochrane and Medline was performed. Studies were reviewed independently for methodology, inclusion and exclusion criteria and endpoints. Primary endpoints were incidence of in-hospital adverse events and percentage of preventability. Secondary endpoints were adverse event outcome and subdivision by provider of care, location and type of event.


RESULTS
Eight studies including a total of 74 485 patient records were selected. The median overall incidence of in-hospital adverse events was 9.2%, with a median percentage of preventability of 43.5%. More than half (56.3%) of patients experienced no or minor disability, whereas 7.4% of events were lethal. Operation- (39.6%) and medication-related (15.1%) events constituted the majority. We present a summary of evidence-based interventions aimed at these categories of events.


CONCLUSIONS
Adverse events during hospital admission affect nearly one out of 10 patients. A substantial part of these events are preventable. Since a large proportion of the in-hospital events are operation- or drug-related, interventions aimed at preventing these events have the potential to make a substantial difference.
Department of Surgery, Academic Medical Centre, University of Amsterdam, The Netherlands.
E N
EN
de Vries
M A
MA
Ramrattan
S M
SM
Smorenburg
D J
DJ
Gouma
M A
MA
Boermeester
D003627:Data Interpretation, Statistical; D006302:Health Services Research; D006761:Hospitals / Q000592:standards; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D012308:Risk Management / Q000379:methods