Ambulatory care in France: too many adverse events

A French study of adverse events linked to ambulatory care (the Evisa study) was conducted in France in 2008, using the same methodology as a 2004 national study (Eneis 1). It included 2946 patients hospitalised in the Aquitaine region and was designed to determine the proportion of hospital admissions that were due to serious adverse events in ambulatory care, as well as the proportion that were preventable. The overall mortality rate was not studied. Overall, 2.5% of hospitalised patients were admitted for adverse events related to ambulatory care, while the rate was as high as 14% in geriatric and neurology wards. About 75% of the patients were admitted following therapeutic interventions, 20% after diagnostic procedures, and 5% after preventive procedures. The adverse events were considered preventable in nearly half of the cases. Drugs were involved in about 80% of the preventable serious adverse events, especially vitamin K antagonists, neuroleptics and diuretics. Twenty-nine cases were analysed in depth.The mechanisms leading to preventable serious adverse events necessitating hospitalisation were similar to those identified in 2004: lack of communication between caregivers, failure to regularly reassess ongoing treatments or health status, and difficulties in obtaining access to care. In practice, identifying and intercepting medical errors should be a priority for all healthcare professionals.