title: The Global Trigger Tool shows that one out of seven patients suffers harm in Palestinian hospitals: challenges for launching a strategic safety plan.
abstract: OBJECTIVE
  The aim of this study was to evaluate patient safety levels in Palestinian hospitals and to provide guidance for policymakers involved in safety improvement efforts.
  
  
  METHODS
  Retrospective review of hospitalized patient records using the Global Trigger Tool.
  
  
  METHODS
  Two large hospitals in Palestine: a referral teaching hospital and a nonprofit, non-governmental hospital.
  
  
  METHODS
  A total of 640 random records of discharged patients were reviewed by experienced nurses and physicians from the selected hospitals.
  
  
  METHODS
  Assessment of adverse events.
  
  
  METHODS
  Prevalence of adverse events, their preventability and harm category. Descriptive statistics and Cohen kappa coefficients were calculated.
  
  
  RESULTS
  One out of seven patients (91 [14.2%]) suffered harm. Fifty-four (59.3%) of these events were preventable; 64 (70.4%) resulted in temporary harm, requiring prolonged hospitalization. Good reliability was achieved among the independent reviewers in identifying adverse events. The Global Trigger Tool showed that adverse events in Palestinian hospitals likely occur at a rate of 20 times higher than previously reported. Although reviewers reported that detecting adverse events was feasible, we identified conditions suggesting that the tool may be challenging to use in daily practice.
  
  
  CONCLUSIONS
  One out of seven patients suffers harm in Palestinian hospitals. Compromised safety represents serious problems for patients, hospitals and governments and should be a high priority public health issue. We argue that direct interventions should be launched immediately to improve safety. Additional costs associated with combating adverse events should be taken into consideration, especially in regions with limited resources, as in Palestine.
authors.affiliation: Health Services Research Group, School of Public Health, KU Leuven, Kapucijnenvoer 35, 4th Floor, B-3000 Leuven, Belgium. shahenaz.najjar@med.kuleuven.be.
authors.forename: Shahenaz
authors.initials: S
authors.lastname: Najjar
authors.forename: Motasem
authors.initials: M
authors.lastname: Hamdan
authors.forename: Martin C
authors.initials: MC
authors.lastname: Euwema
authors.forename: Arthur
authors.initials: A
authors.lastname: Vleugels
authors.forename: Walter
authors.initials: W
authors.lastname: Sermeus
authors.forename: Rashad
authors.initials: R
authors.lastname: Massoud
authors.forename: Kris
authors.initials: K
authors.lastname: Vanhaecht
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018912:Arabs / Q000706:statistics & numerical data*; D005260:Female; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D008875:Middle Aged; D061214:Patient Safety; D015995:Prevalence; D012189:Retrospective Studies; D017751:Safety Management / Q000458:organization & administration; D055815:Young Adult
keywords: Global Trigger Tool; adverse event; harm; patient safety; retrospective review Palestine