Using prospective clinical surveillance to identify adverse events in hospital

BACKGROUND: To improve patient safety, organisations must systematically measure avoidable harms. Clinical surveillance—consisting of prospective case finding and peer review—could improve identification of adverse events (AEs), preventable AEs and potential AEs. The authors sought to describe and compare findings of clinical surveillance on four clinical services in an academic hospital. METHODS: Clinical surveillance was performed by a nurse observer who monitored patients for prespecified clinical events and collected standard information about each event. A multidisciplinary, peer-review committee rated causation for each event. Events were subsequently classified in terms of severity and type. RESULTS: The authors monitored 1406 patients during their admission to four hospital services: Cardiac Surgery Intensive Care (n=226), Intensive Care (n=211), General Internal Medicine (n=453) and Obstetrics (n=516). The authors detected 245 AEs during 9300 patient days of observation (2.6 AEs per 100 patient days). 88 AEs (33%) were preventable. The proportion of patients experiencing at least one AE, preventable AE or potential AE was 13.7%, 6.1% and 5.3%, respectively. AE risk varied between services, ranging from 1.4% of Obstetrics to 11% of Internal Medicine and Intensive Care patients experiencing at least one preventable AE. The proportion of patients experiencing AEs resulting in permanent disability or death varied between services: ranging from 0.2% on Obstetrics to 4.9% on Cardiac Surgery Intensive Care. No services shared the most frequent AE type. CONCLUSIONS: Using clinical surveillance, the authors identified a high risk of AE and significant variation in AE risks and subtypes between services. These findings suggest that institutions will need to evaluate service-specific safety problems to set priorities and design improvement strategies.