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Cancer. 2017 Dec 1;123(23):4728-4736. doi: 10.1002/cncr.30916. Epub 2017 Aug 17.

Preventable and mitigable adverse events in cancer care: Measuring risk and harm across the continuum.

Author information

1
Memorial Sloan Kettering Cancer Center, New York, New York.
2
Pascal Metrics, Washington, DC.
3
University of Utah School of Medicine, Salt Lake City, Utah.
4
Tufts Medical Center, Boston, Massachusetts.
5
Tufts University School of Medicine, Boston, Massachusetts.

Abstract

BACKGROUND:

Patient safety is a critical concern in clinical oncology, but the ability to measure adverse events (AEs) across cancer care is limited by a narrow focus on treatment-related toxicities. The objective of this study was to assess the nature and extent of AEs among cancer patients across inpatient and outpatient settings.

METHODS:

This was a retrospective cohort study of 400 adult patients selected by stratified random sampling who had breast (n = 128), colorectal (n = 136), or lung cancer (n = 136) treated at a comprehensive cancer center in 2012. Candidate AEs, or injuries due to medical care, were identified by trained nurse reviewers over the course of 1 year from medical records and safety-reporting databases. Physicians determined the AE harm severity and the likelihood of preventability and harm mitigation.

RESULTS:

The 400-patient sample represented 133,358 days of follow-up. Three hundred four AEs were identified for an overall rate of 2.3 events per 1000 patient days (91.2 per 1000 inpatient days and 0.9 per 1000 outpatient days). Thirty-four percent of the patients had 1 or more AEs (95% confidence interval, 29%-39%), and 16% of the patients had 1 or more preventable or mitigable AEs (95% confidence interval, 13%-20%). The AE rate for patients with breast cancer was lower than the rate for patients with colorectal or lung cancer (P ≤ .001). The preventable or mitigable AE rate was 0.9 per 1000 patient days. Six percent of AEs and 4% of preventable AEs resulted in serious harm. Examples included lymphedema, abscess, and renal failure.

CONCLUSIONS:

A heavy burden of AEs, including preventable or mitigable events, has been identified. Future research should examine risk factors and improvement strategies for reducing their burden. Cancer 2017;123:4728-4736. © 2017 American Cancer Society.

KEYWORDS:

adverse events; harm; medical error; oncology; patient safety

PMID:
28817180
DOI:
10.1002/cncr.30916
[Indexed for MEDLINE]
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