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Measures of patient safety in developing and emerging countries: a review of the literature
  1. K B Carpenter1,2,
  2. M A Duevel1,
  3. P W Lee2,
  4. A W Wu3,
  5. D W Bates3,4,
  6. W B Runciman3,5,
  7. G R Baker3,6,
  8. I Larizgoitia3,
  9. W B Weeks3,7
  1. 1VA Interdisciplinary Patient Safety Fellowship Program, White River Junction, Vermont, USA
  2. 2Field Office, VA National Center for Patient Safety, White River Junction, Vermont, USA
  3. 3The World Alliance for Patient Safety, Geneva, Switzerland
  4. 4Division of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  5. 5Department of Anaesthesia and Intensive Care, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia
  6. 6Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  7. 7The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
  1. Correspondence to William B Weeks, The Dartmouth Institute for Health Policy and Clinical Practice, Room 209, 35 Centerra Parkway, Lebanon NH 03766, USA; wbw{at}


Context The World Alliance for Patient Safety was formed to accelerate worldwide research progress towards measurably improving patient safety. Although rates of adverse events have been studied in industrialised countries, little is known about the rates of adverse events in developing and emerging countries.

Purpose To review the literature on patient safety issues in developing and emerging countries, to identify patient safety measures presently used in these countries and to propose a method of measurably improving patient safety measurement in these countries.

Methods Using the Medline database for 1998 to 2007, we identified and reviewed 23 English-language articles that examined patient safety measurement in developing and emerging countries.

Results Our review included 12 studies that prospectively measured patient safety and 11 studies that retrospectively measured safety. Two studies used measures of structure and the remaining used process measures, outcome measures or both. Whereas a few studies used surveys or direct observation, most studies used chart audits to measure patient safety. Most studies addressed safety at a single facility.

Conclusions Investigation of patient safety in developing and emerging countries has been infrequent and limited in scope. Establishing fundamental safe patient practices, integrating those processes into routine health services delivery and developing patients' expectations that such processes be present are necessary prerequisites to measuring and monitoring progress towards safe patient care in emerging and developing countries.

  • Patient safety
  • emerging and developing countries
  • literature review
  • assessment

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  • Funding This work was supported in part by the VA's National Center for Patient Safety and the WHO's World Alliance for Patient Safety.

  • Competing interests None. The views expressed in this article do not necessarily represent the views of the Department of Veterans Affairs or of the United States government.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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