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BMJ. 2019 Jul 17;366:l4185. doi: 10.1136/bmj.l4185.

Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis.

Author information

1
NIHR Greater Manchester Patient Safety Translational Research Centre, NIHR School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester M13 9PL, UK maria.panagioti@manchester.ac.uk.
2
NIHR Greater Manchester Patient Safety Translational Research Centre, NIHR School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester M13 9PL, UK.
3
Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, UK.
4
Lancashire Teaching Hospitals NHS Foundation Trust, Manchester, UK.
5
Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK.

Abstract

OBJECTIVE:

To systematically quantify the prevalence, severity, and nature of preventable patient harm across a range of medical settings globally.

DESIGN:

Systematic review and meta-analysis.

DATA SOURCES:

Medline, PubMed, PsycINFO, Cinahl and Embase, WHOLIS, Google Scholar, and SIGLE from January 2000 to January 2019. The reference lists of eligible studies and other relevant systematic reviews were also searched.

REVIEW METHODS:

Observational studies reporting preventable patient harm in medical care. The core outcomes were the prevalence, severity, and types of preventable patient harm reported as percentages and their 95% confidence intervals. Data extraction and critical appraisal were undertaken by two reviewers working independently. Random effects meta-analysis was employed followed by univariable and multivariable meta regression. Heterogeneity was quantified by using the I2 statistic, and publication bias was evaluated.

RESULTS:

Of the 7313 records identified, 70 studies involving 337‚ÄČ025 patients were included in the meta-analysis. The pooled prevalence for preventable patient harm was 6% (95% confidence interval 5% to 7%). A pooled proportion of 12% (9% to 15%) of preventable patient harm was severe or led to death. Incidents related to drugs (25%, 95% confidence interval 16% to 34%) and other treatments (24%, 21% to 30%) accounted for the largest proportion of preventable patient harm. Compared with general hospitals (where most evidence originated), preventable patient harm was more prevalent in advanced specialties (intensive care or surgery; regression coefficient b=0.07, 95% confidence interval 0.04 to 0.10).

CONCLUSIONS:

Around one in 20 patients are exposed to preventable harm in medical care. Although a focus on preventable patient harm has been encouraged by the international patient safety policy agenda, there are limited quality improvement practices specifically targeting incidents of preventable patient harm rather than overall patient harm (preventable and non-preventable). Developing and implementing evidence-based mitigation strategies specifically targeting preventable patient harm could lead to major service quality improvements in medical care which could also be more cost effective.

PMID:
31315828
DOI:
10.1136/bmj.l4185
[Indexed for MEDLINE]
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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and all other authors declare no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

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