Dissertation: Adverse events in hospitals

All hospitals have good and bad departments and need to improve patient safety. Most of the hospitals already started. Marieke Zegers defended her PhD thesis on the third of June at the VU medical center in Amsterdam. Her thesis is about the results and the methodological considerations of the record review study on adverse events in Dutch hospitals carried out in 2007.

“Improvement of patient safety starts with insight into the nature and scale of adverse events”, tells Marieke Zegers. The World Health Organisation (WHO) distinguishes five stages in a cycle to enhance patient safety. The Netherlands is at stage four in this cycle: the implementation of safety campaigns. The record review study on adverse events in Dutch hospitals, initiated by the Dutch Society of Medical Specialists, was stage one of the cycle and forms the basis for important improvements.

Adverse events
The national record review study on adverse events in Dutch hospitals carried out in 2007 showed that in 5.7% of the hospitals admissions adverse events were found. Of all adverse events, 40% was judged to be potentially preventable. The study also showed that the scale of adverse events varied more between hospital departments than between hospitals. Marieke Zegers: “This implies that each hospital has departments with low and high proportions of adverse events and that thus all hospitals need to improve patient safety.”

Safety campaign
Since January 2008 the safety campaign “Prevent injury, work safely” started in the hospitals as a reaction on the results of the national record review study. The safety campaign is initiated by the associations of nurses, physicians, and hospitals and is aimed to reduce the scale of adverse events with 50%. Marieke Zegers: “Because the scale of adverse events varied between hospital departments it is important to implement interventions specified for the problems at department level. This is possible with for example the ten topics of the safety campaign which are focussed on specific patient groups and detected patient safety problems.”

Methods
The record review study was carried out in 21 hospitals by the EMGO Institute for Health and Care research and NIVEL, the Netherlands institute for health services research. Patient records of 7926 hospital admissions from 2004 were reviewed systematically by trained physicians and nurses. The study was initiated by the Society of Medical Specialists (Orde van Medisch Specialisten) and is financial supported by the ministry of Health, Welfare and Sports.