International Journal for Quality in Health Care Advance Access originally published online on October 19, 2009
International Journal for Quality in Health Care 2009 21(6):408-414; doi:10.1093/intqhc/mzp047
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Impact and preventability of adverse events in Spanish public hospitals: results of the Spanish National Study of Adverse Events (ENEAS)
1 Department of Preventive Medicine, Teaching Hospital of Sant Joan d'Alacant, Miguel Hernández University of Elche, Spain
2 Department of Public Health, History Science and Gynaechology, Miguel Hernández University of Elche, Spain
3 Department of Preventive Medicine, Teaching Hospital Lozano Blesa, University of Zaragoza, Spain
4 Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Spain
5 Quality Office of the National Health Service, Ministry of Health and Consumption, Spain
6 Agency for Healthcare Research and Quality, Rockville, MD, USA
Objective. To determine the impact and preventability of adverse events (AEs) associated with health care in Spanish hospitals.
Design. Retrospective cohort study.
Setting. Twenty-four Spanish hospitals.
Participants. Patients of any age with a clinical record indicating an inpatient stay of >24 h and a discharge between 4 and 10 June 2005 (n = 5908).
Intervention. None.
Main Outcome Measures. Percentage of AEs considered preventable.
Results. We were able to identify 525 patients suffering AEs associated directly with medical care, who accumulated 655 AEs with 43% of these AEs considered preventable. Overall, 45% (295 AEs) were considered minor, 39% (255 AEs) moderate and 16% (105 AEs) severe. There were no significant differences in AE severity by hospital size, but AEs associated with surgical services were more likely to be severe than those associated with medical services. Some 31.4% of AEs resulted in a longer stay and 23.4% led to hospital admission. AEs associated with medical care caused 6.1 additional days per patient. Of the patients, 66.3% required additional procedures and 69.9% required additional treatments. Incidence of death in patients with AEs was 4.4% (CI 95%: 2.8–6.5). Age over 65 was associated with a higher incidence of preventable AEs. The highest percentages of preventable AEs were related to diagnosis (84.2%), to nosocomial infections (56.6%) and to care (56%).
Conclusions. In Spanish hospitals, AEs associated with health care cause distress, disability, death, lengthen hospital stay and cause increased consumption of health-care resources. A relatively high percentage of AEs in Spain may be preventable with improvements in medical care.
Keywords: adverse events, medical errors, clinical safety, quality of care, patient safety
Address reprint requests to: Jesus Ma Aranaz Andrés, Department of Public Health, Miguel Hernández University (San Juan Campus), Carretera de Alicante a Valencia s/n, 03550 San Juan de Alicante, Spain. Tel: +34 965938821; Fax: +34 965938652; E-mail: aranaz_jes{at}gva.es
Members of the ENEAS work group are listed in Appendix.
Accepted for publication September 23, 2009.