Reporting of adverse events in hospitals in Victoria, 1994-1995

D A O'Hara, N J Carson
Medical Journal of Australia 1997 May 5, 166 (9): 460-3

OBJECTIVE: To describe the nature and frequency of adverse events (AEs) reported in routine inpatient data collection.

DESIGN: Retrospective analysis of data from the Victorian Inpatient Minimum Database.

SETTING: All public (135) and private (112) acute-care hospitals in Victoria, 1994-1995.

PARTICIPANTS: All patients with separations recording an E-code identified as an AE through the International classification of diseases, ninth revision (ICD-9), classification system.

MAIN OUTCOME MEASURES: Australian national diagnosis-related groups (AN-DRGs) associated with AEs; prevalence of major organ system disease in each of the AE groups; AE rates by hospital type; and impact of AEs on discharge destination, or death.

RESULTS: AEs were recorded in 5% of separations, with incidence increasing with patient age. Most (81%) were complications after surgery or other procedures (E878-E879); 19% were adverse drug effects (E930-E949) and 1.7% were misadventures (E870-E876). The most frequently reported complications were infections, haemorrhage and pneumonia. AN-DRGs--joint replacement of the lower limb, bowel excision and hysterectomy--contributed most to the volume of AEs, while the greatest risk was associated with ventricular shunt, major organ transplantation and surgery for complicated injuries. The in-hospital death rate in patients with AEs was 2.9% (95% confidence interval [95% CI], 2.7%-3.2%), compared with 1.3% (95% CI, 1.0-1.4) in those without an AE. Of patients with an AE, fewer were discharged directly home, and higher proportions were discharged to other acute-care facilities or nursing homes compared with those without an AE.

CONCLUSION: Inpatient data collection can provide information about AE rates associated with individual procedures, and the nature of these AEs. It can be used by hospitals to direct and complement their own quality improvement activities. Its limitation is that it cannot identify the severity or long term outcome of AEs.

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