Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 293

There are several ways to measure or estimate the extent of errors or adverse events in healthcare, including analysis of administrative or reporting data, case record review, observations of patient care, and active clinical surveillance. Each of these methods has advantages and disadvantages in terms of availability of data, cost, reliability, observer bias, and clinical relevance. Clearly, the measurement of safety overlaps with the measurement of quality of care, described in other chapters. An adverse event is defined as an unintended injury caused by medical management rather than the disease process, which is sufficiently serious to lead to prolongation of hospitalization or temporary or permanent disability or death.⁴ This definition is important because it has been traditionally used in studies of the nature and scale of harm, described below. A critical incident or ‘near miss’ may be considered the next step down from this incident, which may have caused harm but did not actually do so.

Over the last 40 years, a number of international adverse event studies have been published in which retrospective case record review was used to identify adverse events and assess the nature and scale of harm in acute hospitals. A selection of these studies are shown in Table 11.1. Rates of adverse events in most recent studies lie between 8 and 12%, a range now accepted as typical of advanced healthcare systems. The rate per patient is always slightly higher, as some patients suffer more than one event, and about half of adverse events are generally judged to be preventable. Rates in the United States are much lower, and those in Australia appear to be much higher. The lower US rates might reflect better‐quality care but probably reflect the narrower focus on negligent injury rather than the broader quality improvement focus of most other studies.