title: Epidemiology of medical adverse events: perspectives from a single institute in Taiwan.
abstract: OBJECTIVE
  Epidemiology data of medical adverse events (MAEs) are crucial for patient safety policymaking. However, no epidemiological data on MAE exist in Taiwan. In this study, we aimed to investigate the incidence of MAEs at a major medical center in northern Taiwan.
  
  
  METHODS
  The Harvard Medical Practice Study methodology was modified using a criterion-based screening algorithm and critical medical record review process to investigate the risks and incidences of MAEs. A Criterion-Based Screening for Medical Adverse Events (CBSMAE) checklist was developed, and a three-tier strategy was applied to screen and review 2007 inpatient hospitalizations from a single institution.
  
  
  RESULTS
  A total of 2934 charts was sampled (Tier 1) and 950 possible MAEs were identified (Tier 2). One hundred and sixty-one probable MAE cases were subsequently critically reviewed (Tier 3). Nineteen (0.7%) MAE cases were confirmed. The MAEs involved 10 women and nine men (mean age, 70 years). Most MAEs were from the surgery department [11 (57.9%) patients]. The major admission diagnoses were cardiac diseases [7 (36.8%) patients] with a cardiac problem [13 (31.7%) patients] as the major comorbidity. Major MAE attributes were a staff technique problem [12 (46.2%) patients] and patients' underlying conditions (likelihood rating, 2.2). Eight (42.1%) patients required additional medical management, four (21.1%) patients had a disability, and five (26.3%) patients had in-hospital mortality. Night MAEs (47.4%) were considered preventable.
  
  
  CONCLUSIONS
  Surgical patients with cardiac conditions were at risk of MAE, particularly patients who received invasive procedures. The epidemiology information from this study can serve as baseline data to monitor a patient safety improvement campaign.
authors.affiliation: Quality Management Center, Cathay General Hospital, Taipei, Taiwan; Medical Intensive Care Unit, Cathay General Hospital, Taipei, Taiwan; Graduate Institute of Translational and Interdisciplinary Medicine, National Central University, Taoyuan, Taiwan.
authors.forename: Chen-Hsu
authors.initials: CH
authors.lastname: Wang
authors.affiliation: Ministry of Health and Welfare, Taipei, Taiwan.
authors.forename: Chung-Liang
authors.initials: CL
authors.lastname: Shih
authors.affiliation: Quality Management Center, Cathay General Hospital, Taipei, Taiwan.
authors.forename: Wen-Jing
authors.initials: WJ
authors.lastname: Chen
authors.affiliation: Quality Management Center, Cathay General Hospital, Taipei, Taiwan; Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan.
authors.forename: Sheng-Hui
authors.initials: SH
authors.lastname: Hung
authors.affiliation: Department of Medical Research, Cathay General Hospital, Taipei, Taiwan.
authors.forename: Wei-Jia
authors.initials: WJ
authors.lastname: Jhang
authors.affiliation: Outcome Research Unit, Cathay Medical Research Institute, Cathay General Hospital, Taipei, Taiwan.
authors.forename: Li-Ju
authors.initials: LJ
authors.lastname: Chuang
authors.affiliation: Quality Management Center, Cathay General Hospital, Taipei, Taiwan; Outcome Research Unit, Cathay Medical Research Institute, Cathay General Hospital, Taipei, Taiwan; Department of Otolaryngology, Cathay General Hospital, Taipei, Taiwan; Fu Jen Catholic University School of Medicine, New Taipei City, Taiwan. Electronic address: drtony@seed.net.tw.
authors.forename: Pa-Chun
authors.initials: PC
authors.lastname: Wang
mesh_terms: D000047:Academies and Institutes; D000367:Age Factors; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000145:classification* / Q000706:statistics & numerical data*; D008875:Middle Aged; D061214:Patient Safety / Q000592:standards*; D013624:Taiwan
keywords: epidemiology; medical adverse event