Towards a More Uniform Classification of Patient Safety Events in Solid Organ Transplantation: Applying the World Health Organization International Classification for Patient Safety.

Abstract

Background: Patient safety events have had a dramatic effect on the field of solid organ transplantation. As research in this area increases, the ability to compare findings across institutions will become increasingly important. This comparison will be facilitated in part by a standardized language. The International Classification for Patient Safety (ICPS) and its accompanying conceptual framework were developed by the World Health Organization (WHO) for this purpose. The aim of this study was to adapt the classification for use in safety studies in solid organ transplant. Methods: An interdisciplinary team developed a system of incident classification based on the ICPS. The classification was applied iteratively by four physician coders to web-based safety debriefings. Disagreements were reconciled via consensus until good inter-rater reliability was achieved, and a codebook was developed for future use by researchers. Results: A total of 334 patient safety issues were coded in 270 debriefing responses (31 adverse events, 19 no-harm incidents, 9 near misses, 120 reportable circumstances, 155 contributing factors). The most common incident class reported was Resources/Organizational Management (49/179; 27.4%), of which Human Resources/Staff Availability/Adequacy was the most common subcategory (26/49; 53.1%). The second most common incident class reported was Medical Device/Equipment (39/179; 21.8%), of which Failure/Malfunction was the most common subtype (19/39; 48.7%). Conclusions: We found that the ICPS can be applied to facilitate the analysis of patient safety incidents that occur in solid organ transplant. Prior research has looked at safety in solid organ transplant, but has not applied this system of classification. Assessments of safety vulnerabilities can accelerate progress and by using the WHO Conceptual Framework as a guideline, we can better facilitate the aggregation and dissemination of data.