The prevalence, severity and nature of preventable adverse events in global healthcare: A systematic review and meta-analysis.

Conference:

SAPC ASM 2018 - London

Talk Code:

P2.88

Presenter:

MARIA PANAGIOTI

Twitter:

@MariaPanagiot83

Co-authors:

Kanza Khan, Richard Keers, Denham Phipps, Aseel Abuzour, Evangelos Kontopantelis, Peter Bower, Anthony Avery, Stephen Campbell, Darren Ashcroft

Author institutions:

University of Manchester, University of Nottingham

Problem

Adverse events in healthcare delivery are recognised worldwide as a serious problem. While not all adverse events are preventable, better understanding of preventable adverse events has the potential to impact on healthcare policy and practice in all countries irrespective of models of healthcare system delivery. At present, we lack comprehensive quantitative evidence syntheses focused on preventable adverse events. We aimed to systematically quantify the prevalence, severity and nature of preventable adverse events across global healthcare settings.

Approach

For this systematic review and meta-analysis, we searched 7 databases, including PubMed, PsycINFO, CINAHL, EMBASE, and MEDLINE, using a comprehensive search strategy to identify studies on preventable adverse events published from inception to December 18, 2017. Studies reporting estimates of prevalence, severity and nature of preventable adverse events in patients treated in any healthcare setting were included in the analyses. Random-effects meta-analysis was employed, to account for study heterogeneity, which was further explored in univariable and multivariable meta-regressions. Study quality was assessed with an appropriate risk of bias tool for observational studies, while publication bias was also evaluated.

Findings

Of the 6,415 records identified, 68 studies with 274,405 patients were included in the meta-analysis. The pooled prevalence estimate for preventable adverse events was 5.53% (95% CI= 4.93 to 6.14). Heterogeneity was high. Factors strongly associated with overall prevalence included the healthcare setting in which preventable adverse events occurred (hospitals, specialities and primary care) and the method used to determine preventability. A pooled proportion of 13.09% (95% CI= 9.98 to 16.20) of preventable adverse events led to severe patient harm or death. Incidents related to medication and other therapeutic management accounted for the largest proportion of preventable adverse events (24.81%, 95%CI=16.09 to 33.53), followed by invasive clinical procedures (24.27%, 95% CI=20.67 to 29.88).

Consequences

Around one in 20 patients in healthcare services experience preventable adverse events which are attributable to inadequate or unmet patient safety standards. Evidence-based mitigation strategies targeting preventable adverse events can lead to major service quality improvements in healthcare. Despite this, preventable adverse events remain a neglected outcome in the global patient safety literature compared to overall adverse events.

Submitted by:

MARIA PANAGIOTI

Funding acknowledgement:

This work was funded by the General Medical Council in the UK and the NIHR Greater Manchester Patient Safety Translational Research Centre. This work was supported by the National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre (NIHR Greater Manchester PSTRC).