title: Healthcare processes must be improved to reduce the occurrence of orthopaedic adverse events.
abstract: BACKGROUND
  Many nonhealth industries have decades of experiences working with safety systems. Similar systems are also needed in healthcare to improve patient safety. Clinical incident reporting systems in healthcare identify adverse events but seriously underestimate the incidence of adverse events. A wide range of information sources and monitoring techniques are needed to understand and mitigate healthcare risks.
  
  
  OBJECTIVE
  The purpose of this study was to identify patient safety risk factors that can lead to adverse events in adult orthopaedic inpatients.
  
  
  METHODS
  A three-stage structured retrospective patient record review of consecutively admitted patients to the inpatient service of a large, urban Swedish hospital.
  
  
  METHODS
  Records for all orthopaedic inpatients admitted during a 2-month period (n = 395) were screened using 12 criteria. Positive records were then reviewed in two stages by orthopaedic surgeons using a standardized protocol. Data were collected from the index admission and from subsequent visits or readmissions within 28 days of discharge.
  
  
  RESULTS
  Sixty patients experienced 65 healthcare associated adverse events. Affected patients had a length of hospital stay double that of patients without adverse events. Adverse events were more common in patients undergoing surgical procedures and patients with risk factors for anaesthesia. Although 59 of the adverse events occurred in patients who underwent surgery, only nine of the adverse events were due to deficiencies in surgical/anaesthesia technique. The others were related to deficiencies in healthcare processes. The most common adverse events were hospital acquired infections (n = 20) and delayed detection of urinary retention (n = 13). Six adverse drug events involved elderly patients (≥65 years).
  
  
  CONCLUSIONS
  Orthopaedic care is a high risk activity for its typically elderly, often debilitated patients. Reducing adverse events in orthopaedic patients will require more multidisciplinary, interdepartmental teamwork strategies that focus on healthcare processes outside the operating room.
authors.affiliation: Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden. maria.unbeck@ds.se
authors.forename: Maria
authors.initials: M
authors.lastname: Unbeck
authors.forename: Nils
authors.initials: N
authors.lastname: Dalen
authors.forename: Olav
authors.initials: O
authors.lastname: Muren
authors.forename: Ulf
authors.initials: U
authors.lastname: Lillkrona
authors.forename: Karin Pukk
authors.initials: KP
authors.lastname: Härenstam
mesh_terms: D006801:Humans; D019637:Orthopedic Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013548:Sweden