reports

Application of patient safety indicators in Manitoba: a first look.

Winnipeg, MB, Canada: Manitoba Centre for Health Policy.

Manitoba Centre for Health Policy, Winnipeg, MB, Canada

Although there has always been an interest in patient safety, a heightened  awareness emerged after the publication of the landmark Institute of  Medicine (IOM) Report, To Err is Human: Building a Safer Health System  (Institute of Medicine, 2000). The Report included estimates of the prevalence  of in-hospital adverse events and the numbers of people who died  annually in U.S. hospitals as a result of medical error. According to the  IOM Report, adverse events occur in 3 to 4% of all hospitalizations, and  between 44,000 and 98,000 patients die each year in U.S. hospitals as a  result of medical error. These estimates were alarming and sparked renewed  investigations into the safety of patients in hospital. Since the publication of  the IOM Report, additional estimates of the frequency and severity of inhospital  adverse events have been derived. Depending on the event and case  definition, the frequency of adverse events ranges from 5 to 20% of hospitalizations.  Under-reporting is also acknowledged.

Much of the research to date on in-hospital patient safety has been completed  through medical records review. The impact of such research on the  practice and policy environments has been significant. Notwithstanding the  quality of the information derived, medical record reviews are time consuming,  labour intensive and expensive. Limited but important research on  patient safety has been completed using large databases. While some of this  research has focussed on specific types of events (e.g., stroke-related fatalities),  the Agency for Healthcare Research and Quality (AHRQ) has developed  indicators of patient safety which cover a broad range of surgical, medical  and obstetric events (Romano et al., 2003). The contribution of these  indicators to the study of in-hospital patient safety is significant because of  the breadth of coverage. For example, multiple indicators of compromised  patient safety related to surgical procedures have been developed (i.e.,  thromboembolism, accidental puncture/laceration, hemorrhage) for which  comparisons of rates can be made between regions, hospitals, sexes and age  groups. This type of information allows for the identification of areas of  concern (e.g., high rates of post-operative hemorrhage at hospitals in a particular  region) which can then be targeted with more intensive investigation  (e.g., medical record review, case review).