Adverse events in orthopedic care identified via the Global Trigger Tool in Sweden - implications on preventable prolonged hospitalizations.

Hans Rutberg,Madeleine Borgstedt-Risberg,Pelle Gustafson,Maria Unbeck

doi:10.1186/s13037-016-0112-y

Abstract

BackgroundThe national incidence of adverse events (AEs) in Swedish orthopedic care has never been described. A new national database has made it possible to describe incidence, nature, preventability and consequences of AEs in Swedish orthopedic care.MethodsWe used national data from a structured two-stage record review with a Swedish modification of the Global Trigger Tool. The sample was 4,994 randomly selected orthopedic admissions in 56 hospitals during 2013 and 2014. The AEs were classified according to the Swedish Patient Safety Act into preventable or non-preventable.ResultsAt least one AE occurred in 733 (15 %, 95 % CI 13.7–15.7) admissions. Of 950 identified AEs, 697 (73 %) were judged preventable. More than half of the AEs (54 %) were of temporary nature. The most common types of AE were healthcare-associated infections and distended urinary bladder. Patients ≥65 years had more AEs (p < 0.001), and were more often affected by pressure ulcer (p < 0.001) and urinary tract infections (p < 0.01). Distended urinary bladder was seen more frequently in patients aged 18–64 years (p = 0.01). Length of stay was twice as long for patients with AEs (p < 0.001). We estimate 232,000 extra hospital days due to AEs during these 2 years. The pattern of AEs in orthopedic care was different compared to other hospital specialties.ConclusionsUsing a national database, we found AEs in 15 % of orthopedic admissions. The majority of the AEs was of temporary nature and judged preventable. Our results can be used to guide focused patient safety work.

Highlights

The national incidence of adverse events (AEs) in Swedish orthopedic care has never been described
A revised version of the method [7] was published in 2012, mainly in order to have a record review (RRR) method compliant with a new Swedish Patient Safety Act, and to incorporate common AEs not included in the original method such as distended urinary bladder, failure in vital signs and neurological injury
950 AEs were identified in 733 patients (15 %, 95 % CI 13.7–15.7), range 1–7 AEs per patient

Summary

Introduction

The national incidence of adverse events (AEs) in Swedish orthopedic care has never been described. A new national database has made it possible to describe incidence, nature, preventability and consequences of AEs in Swedish orthopedic care. A revised version of the method [7] was published in 2012, mainly in order to have a RRR method compliant with a new Swedish Patient Safety Act, and to incorporate common AEs not included in the original method such as distended urinary bladder, failure in vital signs and neurological injury. A few of the original triggers in the GTT manual were omitted since they were seldomly found and in order to improve the review process the trigger definitions were expanded with more detailed instructions for the judgment of AEs and its preventability

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