title: One fourth of unplanned transfers to a higher level of care are associated with a highly preventable adverse event: a patient record review in six Belgian hospitals.
abstract: OBJECTIVE
  The objectives of this study are to determine the prevalence and preventability of adverse events requiring an unplanned higher level of care, defined as an unplanned transfer to the ICU or an in-hospital medical emergency team intervention, and to assess the type and the level of harm of each adverse event.
  
  
  METHODS
  A three-stage retrospective review process of screening, record review, and consensus judgment was performed.
  
  
  METHODS
  Six Belgian acute hospitals.
  
  
  METHODS
  During a 6-month period, all patients with an unplanned need for a higher level of care were selected.
  
  
  METHODS
  The records 6-month period, the records of all patients with an unplanned need for a higher level of care were assessed by a trained clinical team consisting of a research nurse, a physician, and a clinical pharmacist.
  
  
  RESULTS
  Adverse events were found in 465 of the 830 reviewed patient records (56%). Of these, 215 (46%) were highly preventable. The overall incidence rate of patients being transferred to a higher level of care involving an adverse event was 117.6 (95% CI, 106.9-128.3) per 100,000 patient days at risk, of which 54.4 (95% CI, 47.15-61.65) per 100,000 patient days at risk involving a highly preventable adverse event. This means that 25.9% of all unplanned transfers to a higher level of care were associated with a highly preventable adverse event. The adverse events were mainly associated with drug therapy (25.6%), surgery (23.7%), diagnosis (12.4%), and system issues (12.4%). The level of harm varied from temporary harm (55.7%) to long-term or permanent impairment (19.1%) and death (25.2%). Although the direct causality is often hard to prove, it is reasonable to consider these adverse events as a contributing factor.
  
  
  CONCLUSIONS
  Adverse events were found in 56% of the reviewed records, of which almost half were considered highly preventable. This means that one fourth of all unplanned transfers to a higher level of care were associated with a highly preventable adverse event.
authors.affiliation: 1Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium. 2Antwerp Management School, Health Care Management, Antwerp, Belgium. 3Vzw Jessa ziekenhuis, Hasselt, Belgium. 4Ziekenhuis Oost Limburg, Genk, Belgium. 5Algemeen Ziekenhuis Turnhout, Turnhout, Belgium. 6Center for Health Services and Nursing Research, Catholic University Leuven, Belgium.
authors.forename: Kristel
authors.initials: K
authors.lastname: Marquet
authors.forename: Neree
authors.initials: N
authors.lastname: Claes
authors.forename: Elke
authors.initials: E
authors.lastname: De Troy
authors.forename: Gaby
authors.initials: G
authors.lastname: Kox
authors.forename: Martijn
authors.initials: M
authors.lastname: Droogmans
authors.forename: Ward
authors.initials: W
authors.lastname: Schrooten
authors.forename: Frank
authors.initials: F
authors.lastname: Weekers
authors.forename: Annemie
authors.initials: A
authors.lastname: Vlayen
authors.forename: Marjan
authors.initials: M
authors.lastname: Vandersteen
authors.forename: Arthur
authors.initials: A
authors.lastname: Vleugels
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D015897:Comorbidity; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D006739:Hospital Administration / Q000706:statistics & numerical data*; D057209:Hospital Rapid Response Team / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000145:classification / Q000706:statistics & numerical data*; D008875:Middle Aged; D010360:Patient Transfer / Q000706:statistics & numerical data*; D015995:Prevalence; D011787:Quality of Health Care; D012189:Retrospective Studies