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Adverse events and potentially preventable deaths in Dutch hospitals: results of a retrospective patient record review study
  1. M Zegers1,
  2. M C de Bruijne2,
  3. C Wagner1,2,
  4. L H F Hoonhout2,
  5. R Waaijman2,
  6. M Smits1,
  7. F A G Hout2,
  8. L Zwaan2,
  9. I Christiaans-Dingelhoff2,
  10. D R M Timmermans2,
  11. P P Groenewegen1,
  12. G van der Wal2
  1. 1
    NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
  2. 2
    EMGO Institute, VU University Medical Centre, Amsterdam, the Netherlands
  1. M Zegers, NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands; m.zegers{at}


Objective: This study determined the incidence, type, nature, preventability and impact of adverse events (AEs) among hospitalised patients and potentially preventable deaths in Dutch hospitals.

Methods: Using a three-stage retrospective record review process, trained nurses and doctors reviewed 7926 admissions: 3983 admissions of deceased hospital patients and 3943 admissions of discharged patients in 2004, in a random sample of 21 hospitals in the Netherlands (4 university, 6 tertiary teaching and 11 general hospitals). A large sample of deceased patients was included to determine the occurrence of potentially preventable deaths in hospitals more precisely.

Results: One or more AEs were found in 5.7% (95% CI 5.1% to 6.4%) of all admissions and a preventable AE in 2.3% (95% CI 1.9% to 2.7%). Of all AEs, 12.8% resulted in permanent disability or contributed to death. The proportion of AEs and their impact increased with age. More than 50% of the AEs were related to surgical procedures. Among deceased hospital patients, 10.7% (95% CI 9.8% to 11.7%) had experienced an AE. Preventable AEs that contributed to death occurred in 4.1% (95% CI 3.5% to 4.8%) of all hospital deaths. Extrapolating to a national level, between 1482 and 2032 potentially preventable deaths occurred in Dutch hospitals in 2004.

Conclusions: The incidence of AEs, preventable AEs and potentially preventable deaths in the Netherlands is substantial and needs to be reduced. Patient safety efforts should focus on surgical procedures and older patients.

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  • Additional appendices are published online only at

  • Funding: The Dutch Patient Safety Research Program was initiated by the Orde van Medisch Specialisten [Dutch Society of Medical Specialists] and the Dutch Institute for Healthcare Improvement (CBO) with financial support from the Ministry of Health, Welfare and Sport. The programme is being carried out by EMGO Institute/VUmc and NIVEL.

  • Competing interests: None.