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Abstract
Objectives To describe the implementation of a trigger tool in Sweden and present the national incidence of adverse events (AEs) over a 4-year period during which an ongoing national patient safety initiative was terminated.
Design Cohort study using retrospective record review based on a trigger tool methodology.
Setting and participants Patients ≥18 years admitted to all somatic acute care hospitals in Sweden from 2013 to 2016 were randomised into the study.
Primary and secondary outcome measures Primary outcome measure was the incidence of AEs, and secondary measures were type of injury, severity of harm, preventability of AEs, estimated healthcare cost of AEs and incidence of AEs in patients cared for in another type of unit than the one specialised for their medical needs (‘off-site’).
Results In a review of 64 917 admissions, the average AE rates in 2014 (11.6%), 2015 (10.9%) and 2016 (11.4%) were significantly lower than in 2013 (13.1%). The decrease in the AE rates was seen in different age groups, in both genders and for preventable and non-preventable AEs. The decrease comprised only the least severe AEs. The types of AEs that decreased were hospital-acquired infections, urinary bladder distention and compromised vital signs. Patients cared for ‘off-site’ had 84% more preventable AEs than patients cared for in the appropriate units. The cost of increased length of stay associated with preventable AEs corresponded to 13%–14% of the total cost of somatic hospital care in Sweden.
Conclusions The rate of AEs in Swedish somatic hospitals has decreased from 2013 to 2016. Retrospective record review can be used to monitor patient safety over time, to assess the effects of national patient safety interventions and analyse challenges to patient safety such as the increasing care of patients ‘off-site’. It was found that the economic burden of preventable AEs is high.
- adverse event
- patient harm
- patient safety
- trigger tool
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Footnotes
Contributors All authors designed and conducted the study. MB-R statistically analysed the data. HR, UN and CÅ undertook the initial interpretation of the data, which was followed by discussions with all the authors. LN and HR drafted the initial version of the manuscript, which was followed by a critical revision process of the intellectual content involving all the authors. All the authors agreed to the final version of the manuscript before submission. All authors agreed to be accountable for the accuracy of any part of the work.
Funding This work was supported by the Swedish Association of Local Authorities and Regions by creating and hosting a national database for the reporting of data from the record reviews.
Competing interests None declared.
Patient consent Not required.
Ethics approval We used retrospective record review to investigate adverse events as part of a structured quality improvement. The principles published in the National Ethical Guidelines for Research were followed (SFS 2003:460). Names and personal identification numbers were not collected or entered into the database.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.