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Int Orthop. 2016 Nov;40(11):2233-2238. Epub 2016 Sep 1.

Incidence and preventability of adverse events in an orthopaedic unit: a prospective analysis of four thousand, nine hundred and six admissions.

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Department of Orthopaedic Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India.
Department of Orthopaedic Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India.



We aimed to identify the incidence and preventability rate of adverse events (AEs) occurring in a specialty orthopaedic unit.


Four thousand nine hundred and six consecutive in-patient admissions over six months in an orthopaedic unit were prospectively analysed. The total indoor patient capacity was segregated into 25-bed units each, and AEs were recorded on a daily basis by two observers. Each event was assessed by allotting a causation score (1-6), with a score of ≥ 4 implying a systemic/individual failure of healthcare provision. A preventability score (1-6) was allotted and scores ≥ 4 were considered to be preventable.


Four hundred and sixty-seven patients (9.5 %) suffered a total of 529 AEs, including 127 readmissions; 49 patients suffering multiple events. Three hundred and thirty-three (62.9 %) events had a causation score of ≥ 4, indicating a failure of healthcare delivery systems. Three hundred and one (56.8 %) events could have been prevented with better regulation and adherence to management protocols. Hospital-acquired infections were the most common event, with surgical-site infection in 102 cases (19.2 and 2 % overall) and catheter-associated urinary tract infections noted in 45 (8.5 %) patients. Medical events included seven deep vein thrombosis, two pulmonary embolisms, five myocardial infarctions and one stroke. AEs occurred 56.3 % in the ward, 4.3 % in the intensive care unit (ICU), 6.2 % in the emergency room, and 9.0 % in the operating theatre.


This prospective study documented an adverse event rate of 9.5 %, of which 56 % were preventable. AEs occurred in all stages of treatment care, emphasising the need for vigilance during the entire treatment process.


Adverse event; Disability; Hospital-acquired infection; Injury; Prevention; Quality in health care

[Indexed for MEDLINE]

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