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Detecting and reducing hospital adverse events: outcomes of the Wimmera clinical risk management program
A M Wolff1, J Bourke, I A Campbell
1Clinical Risk Management Unit, Wimmera Health Care Group, Horsham, VIC. whcgmed@netconnect.com.au
Objectives:
To determine if an integrated clinical risk management program that detects adverse patient events in a hospital, analyses their risk and takes action can alter the rate of adverse events.
Design:
Longitudinal survey of adverse patient events over eight years of progressive implementation of the risk management program.
Participants And Setting:
49,834 inpatients (July 1991 to September 1999) and 20,050 emergency department patients (October 1997 to September 1999) at a rural base hospital in the Wimmera region of Victoria.
Main Outcome Measures:
Rates of adverse events detected by medical record review and clinical incident and general practitioner reporting.
Results:
The annual rate of inpatient adverse events decreased between the first and eighth years of the study from 1.35% of all patient discharges (69 events) to 0.74% (49 events) (P<0.001). Absolute risk reduction was 0.61% (95% CI, 0.23%-0.99%), and relative risk reduction was 44.9% (95% CI, 16.9%-72.9%). The quarterly rate of emergency department adverse events decreased between the first and eighth quarters of monitoring from 3.26% of all attendances (84 events) to 0.48% (12 events) (P< 0.001). Absolute risk reduction was 2.78% (95% CI, 2.04%-3.52%), and relative risk reduction was 85.3% (95% CI, 62.7%-100%).
Conclusions:
Adverse patient events can be detected, and their frequency reduced, using multiple detection methods and clinical improvement strategies as part of an integrated clinical risk management program.