Patient safety has been a central concern in healthcare systems worldwide, especially regarding inpatient care. Over the past few decades, various studies have shed light on the prevalence of adverse events unintended injuries or complications caused by medical management during hospitalisations. Despite significant efforts to improve safety protocols and reduce harm, recent data indicates that patient safety remains a critical issue, with adverse events still occurring at concerning rates. This NEJM article explores the current state of inpatient safety, examines the types of adverse events most commonly encountered, and discusses the ongoing efforts and challenges in improving patient safety.
The Prevalence of Adverse Events in Inpatient Care
Adverse events during hospitalisations are alarmingly common, with nearly one in four admissions involving at least one such event. The most recent data, drawn from a study of 11 hospitals in Massachusetts, revealed that 23.6% of inpatient admissions in 2018 experienced at least one adverse event. Among these, 22.7% were deemed preventable, underscoring the significant potential for improving patient safety. Adverse events range from minor issues that require minimal intervention to severe cases leading to prolonged recovery or even death. The study identified that preventable adverse events with serious consequences occurred in approximately 1% of all admissions, highlighting the critical need for ongoing vigilance and improvement in healthcare practices.
Types of Adverse Events and Their Impact
Adverse events in healthcare can be broadly categorised into several types, with adverse drug events (ADEs), surgical or procedural complications, patient-care events, and healthcare-associated infections (HAIs) being the most prevalent. Adverse drug events were the most frequent, accounting for 39% of all adverse events identified. These events included medication errors that resulted in significant patient harm, such as hypotension, mental status changes, and acute kidney injury. Surgical or procedural complications followed, comprising 30.4% of adverse events, with issues like haemorrhage and urinary retention being particularly notable. Patient-care events, including falls and pressure ulcers, represented 15% of adverse events and were often preventable. Healthcare-associated infections, though less common, had a high likelihood of causing severe or fatal outcomes, particularly infections like pneumonia and surgical site infections.
Challenges in Measuring and Reducing Adverse Events
Despite advancements in medical technology and safety protocols, measuring and reducing adverse events remains a significant challenge. The complexity of modern healthcare, the increased use of electronic health records (EHRs), and the shift of many complex procedures to outpatient settings have all contributed to the difficulty in accurately tracking and preventing these events. Traditional methods of identifying adverse events, such as voluntary reporting, are often inadequate, leading to underreporting and a false sense of safety. Moreover, there is considerable variability in adverse event rates among hospitals, with larger institutions frequently reporting higher rates due to the increased complexity of cases they handle. This variability suggests that more standardised and reliable methods of tracking adverse events are needed to understand better and address the root causes of patient harm.
Conclusion
The quest to improve patient safety in inpatient care is far from over. While significant strides have been made in reducing certain types of adverse events, the persistence of preventable harm highlights the need for continued focus and innovation in healthcare safety practices. Hospitals must invest in better tools for detecting and reporting adverse events, such as leveraging artificial intelligence and advanced data analytics, to provide a more accurate picture of patient safety. Additionally, fostering a culture of transparency and continuous improvement is crucial in reducing the incidence of preventable harm. By addressing these challenges head-on, the healthcare system can make meaningful progress toward ensuring that every patient receives safe and effective care during their hospital stay.
References:
Bates D W, Levine D M, Salmasian H et al. (2023) The Safety of Inpatient Health Care. N Engl J Med. 388(2):142-153
