Article Text

The Irish National Adverse Events Study (INAES): the frequency and nature of adverse events in Irish hospitals—a retrospective record review study
  1. Natasha Rafter1,
  2. Anne Hickey2,
  3. Ronan M Conroy3,
  4. Sarah Condell4,
  5. Paul O'Connor5,
  6. David Vaughan6,
  7. Gillian Walsh7,
  8. David J Williams1
  1. 1Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
  2. 2Division of Population Health Sciences, Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
  3. 3Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
  4. 4Office of the Nursing and Midwifery Services Director, Health Service Executive, Dublin, Ireland
  5. 5Discipline of General Practice, National University of Ireland, Galway, Ireland
  6. 6Quality Improvement, Royal College of Physicians of Ireland, Dublin, Ireland
  7. 7Department of Research, Royal College of Physicians of Ireland, Dublin, Ireland
  1. Correspondence to Dr Natasha Rafter, Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin 2, Ireland; natasharafter{at}rcsi.ie

Abstract

Introduction Irish healthcare has undergone extensive change recently with spending cuts and a focus on quality initiatives; however, little is known about adverse event occurrence.

Objective To assess the frequency and nature of adverse events in Irish hospitals.

Methods 1574 (53% women, mean age 54 years) randomly selected adult inpatient admissions from a sample of eight hospitals, stratified by region and size, across the Republic of Ireland in 2009 were reviewed using two-stage (nurse review of patient charts, followed by physician review of triggered charts) retrospective chart review with electronic data capture. Results were weighted to reflect the sampling strategy. The impact on adverse event rate of differing application of international adverse event criteria was also examined.

Results 45% of charts were triggered. The prevalence of adverse events in admissions was 12.2% (95% CI 9.5% to 15.5%), with an incidence of 10.3 events per 100 admissions (95% CI 7.5 to 13.1). Over 70% of events were considered preventable. Two-thirds were rated as having a mild-to-moderate impact on the patient, 9.9% causing permanent impairment and 6.7% contributing to death. A mean of 6.1 added bed days was attributed to events, representing an expenditure of €5550 per event. The adverse event rate varied substantially (8.6%–17.0%) when applying different published adverse event eligibility criteria.

Conclusions This first study of adverse events in Ireland reports similar rates to other countries. In a time of austerity, adverse events in adult inpatients were estimated to cost over €194 million. These results provide important baseline data on the adverse event burden and, alongside web-based chart review, provide an incentive and methodology to monitor future patient-safety initiatives.

  • Adverse events, epidemiology and detection
  • Patient safety
  • Trigger tools
  • Chart review methodologies

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors NR: design, acquisition of data, analysis and interpretation of the data and drafting of the manuscript. DW and AH: design, reviewed analysis and interpretation of the data and critical revision of drafted manuscript. RMC: design, analysis and interpretation of the data and critical revision of drafted manuscript. SC: design, acquisition of data, interpretation of data and critical revision of drafted manuscript. GW, POC and DV: design, interpretation of data and critical revision of drafted manuscript. All authors approved the final version of the article.

  • Funding Health Research Board (RCQPS/2013/1), Health Service Executive.

  • Competing interests None declared.

  • Ethics approval Ethical approval was obtained from the research ethics committees of the Royal College of Surgeons in Ireland (REC815) and the Royal College of Physicians of Ireland (RCPI RECSAF 04).

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

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