Adverse Events

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Continuing Education Activity

Adverse events (AE) frequently occur in our medical system, and at least one in ten patients are affected. An AE is a harmful and negative outcome that happens when a patient has been provided with medical care. This activity reviews the evaluation and management of an adverse event and highlights the role of interprofessional team members in collaborating to evaluate and manage the adverse event.

Objectives:

  • Explain the importance of monitoring patients for an adverse event.

  • Identify the common causes of an adverse event.

  • Review the management of an adverse event.

  • Review the importance of improving care coordination among interprofessional team members to improve outcomes for patients affected by an adverse event.

Introduction

Adverse events (AE) frequently occur in any medical system, and at least one in ten patients are affected.[1] An AE is a harmful and negative outcome that happens when a patient has been provided with medical care.[2] Medical treatment may include a procedure, surgery, or medication. Any patient who undergoes treatment may experience a negative outcome as a result of that treatment. Adverse events that occur with medical treatment can include medication side effects, injury, psychological harm or trauma, or death. Adverse events can be either preventable or unpreventable and are often associated with medication errors.[3] Adverse events can occur with any provision of care or treatment have a wide range of severity.

Etiology

Adverse events are caused by medical treatment, which injures a patient.[4] There are many methodologies in which an adverse event can occur. The adverse event may be a result of treatment such as surgery or medication. In these instances, the cause may be due to human error or a substance within a medication. Other causes, such as equipment or device failure, can contribute to the occurrence of an adverse event. An adverse event may occur unintended or as a side effect during treatment. However, often the benefit of the treatment may be greater than the temporary harm. Many medications can cause an adverse event to occur, and often patients are on multiple medications.[5][6] 

Poor communication and improper orders or documentation may also contribute to medical errors.[7] When a client is assessed, the potential of a missed diagnosis or an incorrect diagnosis may cause the client to experience an adverse event.[8] Surgical errors are another cause of potential adverse events. Every year, many clients die from surgery or suffer from improper care during treatment, such as wrong-site errors.[8] The place of treatment can also become the cause of treatment. Many adverse events occur from hospitalization. Nosocomial infections are a major cause of deaths every year, and hospitals employ scrutiny in infection control measures.[9] Finally, an early discharge can often result in adverse events such as readmittance or injury.[10]

Epidemiology

In the United States, over 250,000 patients who receive medical care each year will experience an adverse event.[11] Even worse, over 100,000 patients will die from the care that they received.[12] Many vulnerable patients are more at risk for adverse events.[13][14] Globally, it is estimated that approximately ten percent of patients have been affected by at least one adverse event.[15] Countries with less income report higher rates of adverse events.[16] Age disparities exist in the occurrence of adverse events with children and elderly patients affected at higher rates.[17] Racial disparities occur in the populations of patients affected by adverse events, with black patients being affected at significantly higher rates.[18] Socioeconomic factors such as lack of education have been associated with a higher burden of many chronic diseases.[19]. 

A systemic analysis review found an annual incidence of adverse events of around 10%, among which 50% were found to be preventable.[20] The mortality rate following such adverse events was estimated at around 8%. The most common adverse events reported in the literature include:[15]

  1. Relating to surgical specialties
  2. Medications and fluid-related 
  3. Healthcare-associated infections

History and Physical

Any patient who has any untoward effect or outcome experienced with medical treatment is experiencing an adverse event. This can include a wide range of symptoms that fall between the parameters of temporary harm to death.[21][22] At the beginning of care, the healthcare provider should conduct a thorough history and physical. During the history and physical, any limitations of the patient to withstand the treatment should be noted.[23] For example, an elderly patient with limited kidney function should not be placed on a treatment that is excreted in the renal system. The treatment must be tailored to the findings of this history and physical so that the minimalization of adverse events can be achieved. 

Evaluation

When a severe adverse event occurs, it must be evaluated. Evaluation of adverse events should include a patient assessment and related causes. A patient who is receiving treatment should be educated about any potential side effects, and the health care provider should be monitoring the patient for such effects. Symptoms reported by the patient should be assessed. Severe adverse events, such as patient injury or death, are reported and evaluated as sentinel events. The agency will assess the event and discuss the outcome and potential alternative treatments that may have been necessary.[24] Systemic flaws may be evaluated and corrected to prevent future such events. An outside agency will conduct a root cause analysis and issue a response.[8]

As information technology continues to evolve, there are many systems developed to record or even prevent these events.[25] Nationally, the Agency for Healthcare Research and Quality (AHRQ) has developed a list of patient safety indicators (PSI) that should be communicated, and statistical evaluations are continuing to give the medical system and healthcare providers valuable information.[26][27][28] Hospitals can redesign system flaws that are found to contribute to the related adverse event.[29] Treatments that often result in adverse events can be adapted, eliminated, or placed on high alert.[30]

In the United States, many of our healthcare facilities include electronic event reporting systems to collect the voluntary report of an adverse event, but the rates vary widely among facilities.[31][32] A culture of safety currently provides additional avenues for reporting and analysis of medical errors.[33] Quality assurance of care given in our healthcare system includes the further development of adverse event reporting and the systematic response to collected data.[34] 

The study pertaining to the incidence of adverse events in the hospital can be analyzed by the usage of the Global trigger tool and the Harvard method.[15]

There are various strategies in improving the patient's safety and upraising the quality of the relevant tools of quality assurance, such as Plan-Do-Study-Act (PDSA) and the Root Cause Analysis (RCA).[35]

Treatment / Management

Adverse events should be treated at the patient level and ultimately managed at the systemic level. When a patient experiences an adverse event, the healthcare provider should provide timely and appropriate treatment. For example, a patient who experiences nausea can be given an antiemetic medication. Adverse events that occur within the medical system must be reported.[36][37][38] 

Databases of reported adverse events can provide valuable information that can be used to make the necessary changes in care that can decrease or eliminate adverse events.[39][40][41] There has been a discussion about the under-reporting of adverse events.[42] To promote a true culture of doing no harm, clinicians must adopt the approach of reporting all adverse events.[43] The analysis of the information reported will determine the appropriate system management.

Differential Diagnosis

An adverse event is associated with medical treatment. Therefore a medical treatment occurred before or during the occurrence of the adverse event.[8][44][45] There is much variation in the constitution of an adverse event. For example, a medication may cause nausea, and medication may also result in death. The term adverse event is a broad term that can encompass any negative effect. However, a sentinel event is a term used when the result is serious harm or death. Healthcare providers must report adverse events that result in serious harm or death to the patient as sentinel events.[46][47]

Prognosis

A patient who experiences an adverse event from medical care can become harmed or deceased.[7][48] The level of harm that occurred from the adverse event will greatly contribute to the prognosis. A temporary side effect that is quickly managed has a prognosis of complete recovery. A more severe injury may result in a negative prognosis. The prognosis of the adverse event should be clearly communicated with the patient.

Complications

The ultimate complication from an adverse event is multispectral patterns of patient harm.[8][49] Fortunately, many adverse events are treatable. However, permanent injury and patient death can also occur. The healthcare provider should fully inform the patient about any potential complications of medical treatment. This will allow the patient to make informed choices about any care decisions needed by the patient. When the healthcare provider and the patient work together to make informed decisions, shared decision-making is achieved. The patient always has the right to refuse treatment. Unfortunately, other factors, such as cost and convenience, can impair proper health care decision-making.[50]

The mortality following the adverse events in the hospital is reported at a median of around 8%, and the annual secondary cost factor procured in managing them is estimated at around 17 billion dollars.[15]

Deterrence and Patient Education

Patients can deter the incidence of adverse events by becoming involved and knowledgeable in their care.[51][52] Healthcare providers who fully inform the patient, allow for shared decision-making, and tailor treatments to the patient's needs can deter the incidence of adverse events. Adverse events that are expected should be completely reviewed with the patient receiving the care. Furthermore, healthcare providers who report adverse events provide data needed to determine the incidence and significance of the adverse events. Therefore, the medical system needs to support a culture of safe care by providing the resources and support needed to report adverse events.

Pearls and Other Issues

Adverse events frequently occur in healthcare. Healthcare providers must ensure that proper care is given and that patients are monitored for any adverse events. The fragmentation of our current healthcare system poses additional strains on the prevention of adverse events.[53] Patient education upon admission and discharge can help to ensure that the communication of negative outcomes is reported and addressed. When adverse events occur, a thorough review of the incident should be completed, and any needed changes should be made to the care protocols and process. These actions can decrease future adverse events from occurring and improve patient safety.[54]

Enhancing Healthcare Team Outcomes

Every member of the healthcare team can play a part in decreasing the incidence of adverse events. Proper prevention, reporting, follow-up, and analysis can all contribute to better care and the lowered incidence of adverse events. Healthcare team outcomes can be improved through the analysis of adverse events and the development of safer or alternative treatments.[55][56][57][8][58]

The list of reportable adverse events include:[59]

  1. Surgical events - wrong patient, wrong site, wrong procedure, retained foreign body
  2. Product/device related - contaminated products, air embolism
  3. Patient protection events - patient elopement, suicide
  4. Care management issues - medication errors, mismatched blood transfusion
  5. Environmental factors - burn, electric shock, wrong gas
  6. Criminal events - sexual assault, impersonation, physical assault

There is a pivotal need for developing a 'safety first' culture to prioritize our accountability in safeguarding the health of our patients. The implementation of WHO's surgical safety checklist can be the yardstick in minimizing the occurrence of adverse events in surgical specialties.[60]

Details

Author

Christy L. Skelly

Author

Manouchkathe Cassagnol

Editor:

Sunil Munakomi

Updated:

8/13/2023 2:54:05 AM

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References

[1]

de Vries EN, Ramrattan MA, Smorenburg SM, Gouma DJ, Boermeester MA. The incidence and nature of in-hospital adverse events: a systematic review. Quality & safety in health care. 2008 Jun:17(3):216-23. doi: 10.1136/qshc.2007.023622. Epub     [PubMed PMID: 18519629]

Level 2 (mid-level) evidence

[2]

Voskanyan YV. [Safety of patients and adverse events related thereto in medicine]. Angiologiia i sosudistaia khirurgiia = Angiology and vascular surgery. 2018:24(4):11-17     [PubMed PMID: 30531764]

[3]

Kuriakose R, Aggarwal A, Sohi RK, Goel R, Rashmi NC, Gambhir RS. Patient safety in primary and outpatient health care. Journal of family medicine and primary care. 2020 Jan:9(1):7-11. doi: 10.4103/jfmpc.jfmpc_837_19. Epub 2020 Jan 28     [PubMed PMID: 32110556]

[4]

Boulanger J, Keohane C, Yeats A. Role of Patient Safety Organizations in Improving Patient Safety. Obstetrics and gynecology clinics of North America. 2019 Jun:46(2):257-267. doi: 10.1016/j.ogc.2019.02.001. Epub     [PubMed PMID: 31056128]

[5]

Kim J, Parish AL. Polypharmacy and Medication Management in Older Adults. The Nursing clinics of North America. 2017 Sep:52(3):457-468. doi: 10.1016/j.cnur.2017.04.007. Epub     [PubMed PMID: 28779826]

[6]

['Everything' has been taken out and now what?]., Schellen TM,Kragt F,, Tijdschrift voor ziekenverpleging, 1977 Aug 23     [PubMed PMID: 30198943]

[7]

Umberfield E, Ghaferi AA, Krein SL, Manojlovich M. Using Incident Reports to Assess Communication Failures and Patient Outcomes. Joint Commission journal on quality and patient safety. 2019 Jun:45(6):406-413. doi: 10.1016/j.jcjq.2019.02.006. Epub 2019 Mar 29     [PubMed PMID: 30935883]

Level 2 (mid-level) evidence

[8]

Rodziewicz TL, Houseman B, Hipskind JE. Medical Error Reduction and Prevention. StatPearls. 2023 Jan:():     [PubMed PMID: 29763131]

[9]

Habboush Y, Yarrarapu SNS, Guzman N. Infection Control. StatPearls. 2023 Jan:():     [PubMed PMID: 30085559]

[10]

Moriyama H, Kohno T, Kohsaka S, Shiraishi Y, Fukuoka R, Nagatomo Y, Goda A, Mizuno A, Fukuda K, Yoshikawa T, West Tokyo Heart Failure Registry Investigators. Length of hospital stay and its impact on subsequent early readmission in patients with acute heart failure: a report from the WET-HF Registry. Heart and vessels. 2019 Nov:34(11):1777-1788. doi: 10.1007/s00380-019-01432-y. Epub 2019 May 27     [PubMed PMID: 31134379]

[11]

Anderson JG, Abrahamson K. Your Health Care May Kill You: Medical Errors. Studies in health technology and informatics. 2017:234():13-17     [PubMed PMID: 28186008]

[12]

Stewart K, Choudry MI, Buckingham R. Learning from hospital mortality. Clinical medicine (London, England). 2016 Dec:16(6):530-534     [PubMed PMID: 27927816]

[13]

Shen JJ, Cochran CR, Mazurenko O, Moseley CB, Shan G, Mukalian R, Neishi S. Racial and Insurance Status Disparities in Patient Safety Indicators among Hospitalized Patients. Ethnicity & disease. 2016 Jul 21:26(3):443-52. doi: 10.18865/ed.26.3.443. Epub 2016 Jul 21     [PubMed PMID: 27440986]

[14]

Piccardi C, Detollenaere J, Vanden Bussche P, Willems S. Social disparities in patient safety in primary care: a systematic review. International journal for equity in health. 2018 Aug 7:17(1):114. doi: 10.1186/s12939-018-0828-7. Epub 2018 Aug 7     [PubMed PMID: 30086754]

Level 1 (high-level) evidence

[15]

Schwendimann R, Blatter C, Dhaini S, Simon M, Ausserhofer D. The occurrence, types, consequences and preventability of in-hospital adverse events - a scoping review. BMC health services research. 2018 Jul 4:18(1):521. doi: 10.1186/s12913-018-3335-z. Epub 2018 Jul 4     [PubMed PMID: 29973258]

Level 2 (mid-level) evidence

[16]

Johnston BE, Lou-Meda R, Mendez S, Frush K, Milne J, Fitzgerald T, Sexton JB, Rice H. Teaching patient safety in global health: lessons from the Duke Global Health Patient Safety Fellowship. BMJ global health. 2019:4(1):e001220. doi: 10.1136/bmjgh-2018-001220. Epub 2019 Feb 20     [PubMed PMID: 30899564]

[17]

Luo J, Eldredge C, Cho CC, Cisler RA. Population Analysis of Adverse Events in Different Age Groups Using Big Clinical Trials Data. JMIR medical informatics. 2016 Oct 17:4(4):e30     [PubMed PMID: 27751983]

[18]

Metersky ML, Hunt DR, Kliman R, Wang Y, Curry M, Verzier N, Lyder CH, Moy E. Racial disparities in the frequency of patient safety events: results from the National Medicare Patient Safety Monitoring System. Medical care. 2011 May:49(5):504-10. doi: 10.1097/MLR.0b013e31820fc218. Epub     [PubMed PMID: 21494115]

[19]

Dalstra JA, Kunst AE, Borrell C, Breeze E, Cambois E, Costa G, Geurts JJ, Lahelma E, Van Oyen H, Rasmussen NK, Regidor E, Spadea T, Mackenbach JP. Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries. International journal of epidemiology. 2005 Apr:34(2):316-26     [PubMed PMID: 15737978]

Level 3 (low-level) evidence

[20]

Rafter N, Hickey A, Condell S, Conroy R, O'Connor P, Vaughan D, Williams D. Adverse events in healthcare: learning from mistakes. QJM : monthly journal of the Association of Physicians. 2015 Apr:108(4):273-7. doi: 10.1093/qjmed/hcu145. Epub 2014 Jul 29     [PubMed PMID: 25078411]

[21]

Thomas AN, Balmforth JE. Patient Safety Incidents Describing Patient Falls in Critical Care in North West England Between 2009 and 2017. Journal of patient safety. 2021 Mar 1:17(2):e71-e75. doi: 10.1097/PTS.0000000000000574. Epub     [PubMed PMID: 30747859]

[22]

Lowenstern A, Lippmann SJ, Brennan JM, Wang TY, Curtis LH, Feldman T, Glower DD, Hammill BG, Vemulapalli S. Use of Medicare Claims to Identify Adverse Clinical Outcomes After Mitral Valve Repair. Circulation. Cardiovascular interventions. 2019 May:12(5):e007451. doi: 10.1161/CIRCINTERVENTIONS.118.007451. Epub     [PubMed PMID: 31084236]

Level 2 (mid-level) evidence

[23]

Donnelly M, Martin D. History taking and physical assessment in holistic palliative care. British journal of nursing (Mark Allen Publishing). 2016 Dec 8:25(22):1250-1255     [PubMed PMID: 27935339]

[24]

Bolcato M, Fassina G, Rodriguez D, Russo M, Aprile A. The contribution of legal medicine in clinical risk management. BMC health services research. 2019 Feb 1:19(1):85. doi: 10.1186/s12913-018-3846-7. Epub 2019 Feb 1     [PubMed PMID: 30709359]

[25]

Bates DW,Singh H, Two Decades Since To Err Is Human: An Assessment Of Progress And Emerging Priorities In Patient Safety. Health affairs (Project Hope). 2018 Nov     [PubMed PMID: 30395508]

[26]

Narain W. Assessing Estimates of Patient Safety Derived From Coded Data. Journal for healthcare quality : official publication of the National Association for Healthcare Quality. 2017 Jul/Aug:39(4):230-242. doi: 10.1097/JHQ.0000000000000088. Epub     [PubMed PMID: 28658091]

[27]

Owens PL, Limcangco R, Barrett ML, Heslin KC, Moore BJ. Patient Safety and Adverse Events, 2011 and 2014. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. 2006 Feb:():     [PubMed PMID: 30063312]

[28]

Kahwati LC, Sorensen AV, Teixeira-Poit S, Jacobs S, Sommerness SA, Miller KK, Pleasants E, Clare HM, Hirt CL, Davis SE, Ivester T, Caldwell D, Muri JH, Mistry KB. Impact of the Agency for Healthcare Research and Quality's Safety Program for Perinatal Care. Joint Commission journal on quality and patient safety. 2019 Apr:45(4):231-240. doi: 10.1016/j.jcjq.2018.11.002. Epub 2019 Jan 11     [PubMed PMID: 30638973]

Level 2 (mid-level) evidence

[29]

Atkinson MK, Schuster MA, Feng JY, Akinola T, Clark KL, Sommers BD. Adverse Events and Patient Outcomes Among Hospitalized Children Cared for by General Pediatricians vs Hospitalists. JAMA network open. 2018 Dec 7:1(8):e185658. doi: 10.1001/jamanetworkopen.2018.5658. Epub 2018 Dec 7     [PubMed PMID: 30646280]

[30]

Bath J, Dombrovskiy VY, Vogel TR. Impact of Patient Safety Indicators on readmission after abdominal aortic surgery. Journal of vascular nursing : official publication of the Society for Peripheral Vascular Nursing. 2018 Dec:36(4):189-195. doi: 10.1016/j.jvn.2018.08.002. Epub 2018 Oct 2     [PubMed PMID: 30458941]

[31]

Milch CE, Salem DN, Pauker SG, Lundquist TG, Kumar S, Chen J. Voluntary electronic reporting of medical errors and adverse events. An analysis of 92,547 reports from 26 acute care hospitals. Journal of general internal medicine. 2006 Feb:21(2):165-70     [PubMed PMID: 16390502]

[32]

Palojoki S, Borycki EM, Kushniruk AW, Saranto K. A Comparison of Two Principal Systems for Monitoring of Technology-Induced Errors in Electronic Health Records. Studies in health technology and informatics. 2017:245():1108-1112     [PubMed PMID: 29295274]

[33]

Kadzielski MA, Martin C. Assessing medical error in health care. Developing a "culture of safety". Health progress (Saint Louis, Mo.). 2002 Nov-Dec:83(6):31-5     [PubMed PMID: 12420679]

[34]

Schrappe M, Müller H, Hecker R. [Patient safety: current problems and challenges]. Der Internist. 2020 May:61(5):470-474. doi: 10.1007/s00108-020-00779-z. Epub     [PubMed PMID: 32367301]

[35]

Hughes RG, Hughes RG. Tools and Strategies for Quality Improvement and Patient Safety. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. 2008 Apr:():     [PubMed PMID: 21328781]

Level 2 (mid-level) evidence

[36]

Bunting RF Jr. Calculating the frequency of serious reportable adverse events and hospital-acquired conditions. Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management. 2010:30(1):5-8, 11-3, 15-22. doi: 10.1002/jhrm.20038. Epub     [PubMed PMID: 20677240]

[37]

Wu AW, Pronovost P, Morlock L. ICU incident reporting systems. Journal of critical care. 2002 Jun:17(2):86-94     [PubMed PMID: 12096371]

[38]

Lovitky JA. The National Practitioner Data Bank: coping with the uncertainties. Journal of health law. 2000 Spring:33(2):355-79     [PubMed PMID: 11010448]

[39]

Gyorkos TW, St-Denis K. Systematic review of exposure to albendazole or mebendazole during pregnancy and effects on maternal and child outcomes, with particular reference to exposure in the first trimester. International journal for parasitology. 2019 Jun:49(7):541-554. doi: 10.1016/j.ijpara.2019.02.005. Epub 2019 May 6     [PubMed PMID: 31071321]

Level 1 (high-level) evidence

[40]

Dumpa V, Kamity R. Birth Trauma. StatPearls. 2023 Jan:():     [PubMed PMID: 30969653]

[41]

Coldiron B, Fisher AH, Adelman E, Yelverton CB, Balkrishnan R, Feldman MA, Feldman SR. Adverse event reporting: lessons learned from 4 years of Florida office data. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]. 2005 Sep:31(9 Pt 1):1079-92; discussion 1093     [PubMed PMID: 16162309]

[42]

Farquhar C, Armstrong S, Kim B, Masson V, Sadler L. Under-reporting of maternal and perinatal adverse events in New Zealand. BMJ open. 2015 Jul 23:5(7):e007970. doi: 10.1136/bmjopen-2015-007970. Epub 2015 Jul 23     [PubMed PMID: 26204910]

[43]

Cole DA, Bersick E, Skarbek A, Cummins K, Dugan K, Grantoza R. The courage to speak out: A study describing nurses' attitudes to report unsafe practices in patient care. Journal of nursing management. 2019 Sep:27(6):1176-1181. doi: 10.1111/jonm.12789. Epub 2019 Jun 6     [PubMed PMID: 31077621]

[44]

Nikitchenko NV, Khankevych AM, Slynko DV, Savchuk TI, Lazariev VV. A medical error: does law help or hinder. Wiadomosci lekarskie (Warsaw, Poland : 1960). 2019:72(4):697-701     [PubMed PMID: 31055559]

[45]

Holder AR. Medical errors. Hematology. American Society of Hematology. Education Program. 2005:():503-6     [PubMed PMID: 16304427]

[46]

Friedman MM. To tell the truth: the Joint Commission's sentinel event policy. Home healthcare nurse. 1998 Oct:16(10):659-64     [PubMed PMID: 9855937]

[47]

Maturo S, Hughes C, Kallingal G, Silvey S, Johnson AJ, Soderdahl D, Renz E, Brennan J. Improving Surgical Complications and Patient Safety at the Nation's Largest Military Hospital: An Analysis of National Surgical Quality Improvement Program Data. Military medicine. 2017 Mar:182(3):e1752-e1755. doi: 10.7205/MILMED-D-16-00220. Epub     [PubMed PMID: 28290954]

Level 2 (mid-level) evidence

[48]

Wang J, Chen K, Li X, Jin X, An P, Fang Y, Mu Y. Postoperative adverse events in patients with diabetes undergoing orthopedic and general surgery. Medicine. 2019 Apr:98(14):e15089. doi: 10.1097/MD.0000000000015089. Epub     [PubMed PMID: 30946365]

[49]

. The Joint Commission aims for high-reliability health care, unveils framework to move hospitals toward zero harm. ED management : the monthly update on emergency department management. 2013 Dec:25(12):suppl 3-4, 139     [PubMed PMID: 24308070]

[50]

Hay JW. Now Is the Time for Transparency in Value-Based Healthcare Decision Modeling. Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research. 2019 May:22(5):564-569. doi: 10.1016/j.jval.2019.01.009. Epub     [PubMed PMID: 31104735]

[51]

Dahm MR, Georgiou A, Herkes R, Brown A, Li J, Lindeman R, Horvath AR, Jones G, Legg M, Li L, Greenfield D, Westbrook JI. Patient groups, clinicians and healthcare professionals agree - all test results need to be seen, understood and followed up. Diagnosis (Berlin, Germany). 2018 Nov 27:5(4):215-222. doi: 10.1515/dx-2018-0083. Epub     [PubMed PMID: 30332391]

[52]

Berman L, Ottosen M, Renaud E, Hsi-Dickie B, Fecteau A, Skarda D, Goldin A, Rangel S, Tsao K, APSA Quality and Safety Committee. Preventing patient harm via adverse event review: An APSA survey regarding the role of morbidity and mortality (M&M) conference. Journal of pediatric surgery. 2019 Sep:54(9):1872-1877. doi: 10.1016/j.jpedsurg.2018.12.008. Epub 2019 Jan 18     [PubMed PMID: 30765152]

Level 3 (low-level) evidence

[53]

Wipfler K, Hoffmann JE, Mitzkat A, Mahler C, Frankenhauser S. Patient safety - Development, implementation and evaluation of an interprofessional teaching concept. GMS journal for medical education. 2019:36(2):Doc13. doi: 10.3205/zma001221. Epub 2019 Mar 15     [PubMed PMID: 30993171]

[54]

Chapuis C, Chanoine S, Colombet L, Calvino-Gunther S, Tournegros C, Terzi N, Bedouch P, Schwebel C. Interprofessional safety reporting and review of adverse events and medication errors in critical care. Therapeutics and clinical risk management. 2019:15():549-556. doi: 10.2147/TCRM.S188185. Epub 2019 Apr 2     [PubMed PMID: 31037029]

[55]

Wyss UP. Improving the Quality of Life of Patients With Medical Devices by a Timely Analysis of Adverse Events. Frontiers in medicine. 2019:6():56. doi: 10.3389/fmed.2019.00056. Epub 2019 Mar 26     [PubMed PMID: 30972339]

Level 2 (mid-level) evidence

[56]

Ramírez E, Martín A, Villán Y, Lorente M, Ojeda J, Moro M, Vara C, Avenza M, Domingo MJ, Alonso P, Asensio MJ, Blázquez JA, Hernández R, Frías J, Frank A, SINOIRES Working Group. Effectiveness and limitations of an incident-reporting system analyzed by local clinical safety leaders in a tertiary hospital: Prospective evaluation through real-time observations of patient safety incidents. Medicine. 2018 Sep:97(38):e12509. doi: 10.1097/MD.0000000000012509. Epub     [PubMed PMID: 30235764]

[57]

Hooker AB, Etman A, Westra M, Van der Kam WJ. Aggregate analysis of sentinel events as a strategic tool in safety management can contribute to the improvement of healthcare safety. International journal for quality in health care : journal of the International Society for Quality in Health Care. 2019 Mar 1:31(2):110-116. doi: 10.1093/intqhc/mzy116. Epub     [PubMed PMID: 29788153]

Level 2 (mid-level) evidence

[58]

Kirkman MA, Sevdalis N, Arora S, Baker P, Vincent C, Ahmed M. The outcomes of recent patient safety education interventions for trainee physicians and medical students: a systematic review. BMJ open. 2015 May 20:5(5):e007705. doi: 10.1136/bmjopen-2015-007705. Epub 2015 May 20     [PubMed PMID: 25995240]

Level 1 (high-level) evidence

[59]

Henriksen K, Battles JB, Marks ES, Lewin DI, Kizer KW, Stegun MB. Serious Reportable Adverse Events in Health Care. Advances in Patient Safety: From Research to Implementation (Volume 4: Programs, Tools, and Products). 2005 Feb:():     [PubMed PMID: 21250024]

[60]

McLachlan G. WHO's surgical safety checklist: it ain't what you do . . BMJ (Clinical research ed.). 2019 May 20:365():l2237. doi: 10.1136/bmj.l2237. Epub 2019 May 20     [PubMed PMID: 31109953]