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Health services research
Research
Exploring similarities and differences in hospital adverse event rates between Norway and Sweden using Global Trigger Tool
  1. Ellen Tveter Deilkås1,2,
  2. Madeleine Borgstedt Risberg3,
  3. Marion Haugen4,
  4. Jonas Christoffer Lindstrøm2,
  5. Urban Nylén5,
  6. Hans Rutberg6,7,
  7. Soop Michael5
  1. 1National Patient Safety Program, Norwegian Directorate of Health, Oslo, Norway
  2. 2Health Services Research Center, Akershus University Hospital, Lørenskog, Norway
  3. 3Center for Healthcare Development, County Council of Östergötland, Sweden
  4. 4Norwegian Computing Center, Oslo, Norway
  5. 5National Board of Health and Welfare, Stockholm, Sweden
  6. 6Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
  7. 7Swedish Association of Local Authorities and Regions, Stockholm, Sweden
  1. Correspondence to Dr Ellen Tveter Deilkås; elde{at}ahus.no

Abstract

Objectives In this paper, we explore similarities and differences in hospital adverse event (AE) rates between Norway and Sweden by reviewing medical records with the Global Trigger Tool (GTT).

Design All acute care hospitals in both countries performed medical record reviews, except one in Norway. Records were randomly selected from all eligible admissions in 2013. Eligible admissions were patients 18 years of age or older, undergoing care with an in-hospital stay of at least 24 hours, excluding psychiatric and care and rehabilitation. Reviews were done according to GTT methodology.

Setting Similar contexts for healthcare and similar socioeconomic and demographic characteristics have inspired the Nordic countries to exchange experiences from measuring and monitoring quality and patient safety in healthcare. The co-operation has promoted the use of GTT to monitor national and local rates of AEs in hospital care.

Participants 10 986 medical records were reviewed in Norway and 19 141 medical records in Sweden.

Results No significant difference between overall AE rates was found between the two countries. The rate was 13.0% (95% CI 11.7% to 14.3%) in Norway and 14.4% (95% CI 12.6% to 16.3%) in Sweden. There were significantly higher AE rates of surgical complications in Norwegian hospitals compared with Swedish hospitals. Swedish hospitals had significantly higher rates of pressure ulcers, falls and ‘other’ AEs. Among more severe AEs, Norwegian hospitals had significantly higher rates of surgical complications than Swedish hospitals. Swedish hospitals had significantly higher rates of postpartum AEs.

Conclusions The level of patient safety in acute care hospitals, as assessed by GTT, was essentially the same in both countries. The differences between the countries in the rates of several types of AEs provide new incentives for Norwegian and Swedish governing bodies to address patient safety issues.

  • HEALTH SERVICES ADMINISTRATION & MANAGEMENT
  • PUBLIC HEALTH
  • EPIDEMIOLOGY

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-012492

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    Footnotes

    • Contributors ETD was responsible for designing the study in Norway, training of reviewer teams, data collection, analysis and interpretation of data and writing the manuscript. MBR contributed with Swedish data collection and in their interpretation. MH participated in data collection in Norway, in the statistical analysis and interpretation, in addition to critically revising the manuscript. JCL participated in the statistical analysis and interpretation, in addition to revising the manuscript. UN participated in designing the study in Sweden, training of reviewer teams, data collection, analysis and interpretation of data, and revising the manuscript critically. HR participated in designing the study in Sweden, training of reviewer teams, data collection, analysis and interpretation of data and revising the manuscript critically. MS participated in designing the study in Sweden, analysis and interpretation of data and revising the manuscript critically. All authors read and approved the final manuscript.

    • Funding No grants were specifically awarded for this research. Reviewer teams were funded by the hospitals. The research was funded by Akershus University Hospital's Health Services Research Unit, the Norwegian Computing Center and by the Swedish Association of Local Authorities and Regions (SALAR).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The data are administered by the Norwegian Patient Safety Program, at the Norwegian Directorate of Health and by the Swedish Association of Local Authorities and Regions (SALAR). No additional data are available.