Patient harm in general surgery - A prospective study

INTRODUCTION: Retrospective case record analysis indicates that 3% to 17% of hospital inpatients experience harm from their management, surgical patients being particularly at risk. Retrospective record analysis is prone to omission bias, leading to an unknown degree of inaccuracy. AIMS: We aimed to determine the true rate of adverse events in surgical patients by continuous enhanced prospective surveillance and independent analysis by experienced surgeons. METHODS: Admissions to a surgical ward for a single month were prospectively studied, matching their clinical course against staff expectations. An experienced surgeon identified unexpected events and classified them as potentially or actually adverse or not. Three independent consultant surgeons validated these findings and evaluated the preventability of adverse events. RESULTS: One hundred thirteen patients were studied: 84 (74%) were emergencies, and 29 (26%) were elective admissions; 61 patients (54%) underwent an invasive procedure. There were 52 adverse or potentially adverse events in 45 patients (40%). Twenty-nine adverse events occurred in 26 patients (23%), of which, 8 were considered preventable. Invasive procedures were associated with adverse events (34% versus 9.6%; χ1 = 14.52; P = 0.0004), but no difference was observed between emergency and elective admissions (25% versus 24%). There was no significant difference in risk between patients older and younger than 70 years (24% versus 23%; χ1 = 0.686; P > 0.25). CONCLUSIONS: Continuous enhanced prospective surveillance revealed an unexpectedly high rate of potential and actual adverse events among surgical patients, especially in association with invasive maneuvers. This method may be more sensitive than case record review and detects a clinically relevant set of events. © 2007 Lippincott Williams & Wilkins, Inc.