title: Patient safety in developing countries: retrospective estimation of scale and nature of harm to patients in hospital.
abstract: OBJECTIVE
  To assess the frequency and nature of adverse events to patients in selected hospitals in developing or transitional economies.
  
  
  METHODS
  Retrospective medical record review of hospital admissions during 2005 in eight countries.
  
  
  METHODS
  Ministries of Health of Egypt, Jordan, Kenya, Morocco, Tunisia, Sudan, South Africa and Yemen; the World Health Organisation (WHO) Eastern Mediterranean and African Regions (EMRO and AFRO), and WHO Patient Safety.
  
  
  METHODS
  Convenience sample of 26 hospitals from which 15,548 patient records were randomly sampled.
  
  
  METHODS
  Two stage screening. Initial screening based on 18 explicit criteria. Records that screened positive were then reviewed by a senior physician for determination of adverse event, its preventability, and the resulting disability.
  
  
  RESULTS
  Of the 15,548 records reviewed, 8.2% showed at least one adverse event, with a range of 2.5% to 18.4% per country. Of these events, 83% were judged to be preventable, while about 30% were associated with death of the patient. About 34% adverse events were from therapeutic errors in relatively non-complex clinical situations. Inadequate training and supervision of clinical staff or the failure to follow policies or protocols contributed to most events.
  
  
  CONCLUSIONS
  Unsafe patient care represents a serious and considerable danger to patients in the hospitals that were studied, and hence should be a high priority public health problem. Many other developing and transitional economies will probably share similar rates of harm and similar contributory factors. The convenience sampling of hospitals might limit the interpretation of results, but the identified adverse event rates show an estimate that should stimulate and facilitate the urgent institution of appropriate remedial action and also to trigger more research. Prevention of these adverse events will be complex and involves improving basic clinical processes and does not simply depend on the provision of more resources.
authors.affiliation: New York City Health and Hospital Corporation, 125 Worth Street, New York, NY 10013, USA. ross.wilson@nychhc.org
authors.forename: R M
authors.initials: RM
authors.lastname: Wilson
authors.forename: P
authors.initials: P
authors.lastname: Michel
authors.forename: S
authors.initials: S
authors.lastname: Olsen
authors.forename: R W
authors.initials: RW
authors.lastname: Gibberd
authors.forename: C
authors.initials: C
authors.lastname: Vincent
authors.forename: R
authors.initials: R
authors.lastname: El-Assady
authors.forename: O
authors.initials: O
authors.lastname: Rasslan
authors.forename: S
authors.initials: S
authors.lastname: Qsous
authors.forename: W M
authors.initials: WM
authors.lastname: Macharia
authors.forename: A
authors.initials: A
authors.lastname: Sahel
authors.forename: S
authors.initials: S
authors.lastname: Whittaker
authors.forename: M
authors.initials: M
authors.lastname: Abdo-Ali
authors.forename: M
authors.initials: M
authors.lastname: Letaief
authors.forename: N A
authors.initials: NA
authors.lastname: Ahmed
authors.forename: A
authors.initials: A
authors.lastname: Abdellatif
authors.forename: I
authors.initials: I
authors.lastname: Larizgoitia
mesh_terms: D000328:Adult; D000349:Africa; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D006753:Hospital Records / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D008499:Medical Records / Q000706:statistics & numerical data*; D008877:Middle East; D061214:Patient Safety / Q000592:standards*; D011634:Public Health / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods / Q000458:organization & administration; D017751:Safety Management / Q000379:methods / Q000458:organization & administration; D014944:World Health Organization