Exploring similarities and differences in hospital adverse event rates between Norway and Sweden using Global Trigger Tool.
In this paper, we explore similarities and differences in hospital adverse event (AE) rates between Norway and Sweden by reviewing medical records with the Global Trigger Tool (GTT).



All acute care hospitals in both countries performed medical record reviews, except one in Norway. Records were randomly selected from all eligible admissions in 2013. Eligible admissions were patients 18 years of age or older, undergoing care with an in-hospital stay of at least 24 hours, excluding psychiatric and care and rehabilitation. Reviews were done according to GTT methodology.



Similar contexts for healthcare and similar socioeconomic and demographic characteristics have inspired the Nordic countries to exchange experiences from measuring and monitoring quality and patient safety in healthcare. The co-operation has promoted the use of GTT to monitor national and local rates of AEs in hospital care.



10 986 medical records were reviewed in Norway and 19 141 medical records in Sweden.



No significant difference between overall AE rates was found between the two countries. The rate was 13.0% (95% CI 11.7% to 14.3%) in Norway and 14.4% (95% CI 12.6% to 16.3%) in Sweden. There were significantly higher AE rates of surgical complications in Norwegian hospitals compared with Swedish hospitals. Swedish hospitals had significantly higher rates of pressure ulcers, falls and 'other' AEs. Among more severe AEs, Norwegian hospitals had significantly higher rates of surgical complications than Swedish hospitals. Swedish hospitals had significantly higher rates of postpartum AEs.



The level of patient safety in acute care hospitals, as assessed by GTT, was essentially the same in both countries. The differences between the countries in the rates of several types of AEs provide new incentives for Norwegian and Swedish governing bodies to address patient safety issues.
National Patient Safety Program, Norwegian Directorate of Health, Oslo, Norway.|Health Services Research Center, Akershus University Hospital, Lørenskog, Norway.
Ellen Tveter
0000-0001-6527-5636
ET
Deilkås
Center for Healthcare Development, County Council of Östergötland, Sweden.
Madeleine Borgstedt
MB
Risberg
Norwegian Computing Center, Oslo, Norway.
Marion
M
Haugen
Health Services Research Center, Akershus University Hospital, Lørenskog, Norway.
Jonas Christoffer
JC
Lindstrøm
National Board of Health and Welfare, Stockholm, Sweden.
Urban
U
Nylén
Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.|Swedish Association of Local Authorities and Regions, Stockholm, Sweden.
Hans
H
Rutberg
National Board of Health and Welfare, Stockholm, Sweden.
Soop
S
Michael
D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008499:Medical Records / Q000706:statistics & numerical data*; D009664:Norway; D061214:Patient Safety / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D017751:Safety Management / Q000379:methods* / Q000706:statistics & numerical data; D013548:Sweden
EPIDEMIOLOGY; HEALTH SERVICES ADMINISTRATION & MANAGEMENT; PUBLIC HEALTH