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Winnipeg, MB, Canada: Manitoba Centre for Health Policy.
Manitoba Centre for Health Policy, Winnipeg, MB, Canada
Although there has always been an interest in patient safety, a heightened awareness emerged after the publication of the landmark Institute of Medicine (IOM) Report, To Err is Human: Building a Safer Health System (Institute of Medicine, 2000). The Report included estimates of the prevalence of in-hospital adverse events and the numbers of people who died annually in U.S. hospitals as a result of medical error. According to the IOM Report, adverse events occur in 3 to 4% of all hospitalizations, and between 44,000 and 98,000 patients die each year in U.S. hospitals as a result of medical error. These estimates were alarming and sparked renewed investigations into the safety of patients in hospital. Since the publication of the IOM Report, additional estimates of the frequency and severity of inhospital adverse events have been derived. Depending on the event and case definition, the frequency of adverse events ranges from 5 to 20% of hospitalizations. Under-reporting is also acknowledged.
Much of the research to date on in-hospital patient safety has been completed through medical records review. The impact of such research on the practice and policy environments has been significant. Notwithstanding the quality of the information derived, medical record reviews are time consuming, labour intensive and expensive. Limited but important research on patient safety has been completed using large databases. While some of this research has focussed on specific types of events (e.g., stroke-related fatalities), the Agency for Healthcare Research and Quality (AHRQ) has developed indicators of patient safety which cover a broad range of surgical, medical and obstetric events (Romano et al., 2003). The contribution of these indicators to the study of in-hospital patient safety is significant because of the breadth of coverage. For example, multiple indicators of compromised patient safety related to surgical procedures have been developed (i.e., thromboembolism, accidental puncture/laceration, hemorrhage) for which comparisons of rates can be made between regions, hospitals, sexes and age groups. This type of information allows for the identification of areas of concern (e.g., high rates of post-operative hemorrhage at hospitals in a particular region) which can then be targeted with more intensive investigation (e.g., medical record review, case review).
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