Identification of adverse events in orthopaedic practice: a step towards quality care

Adverse Events (AE's) are unintended injuries or complications resulting in death, disability or prolonged hospital stay, that arise from deficiency in the health care management. The objective of this retrospective study is to assess the incidence of AE's, its impact on patients in terms of morbidity and mortality. All orthopaedic patients admitted to the male orthopaedic ward between 1st August 2010 to 31st July 2011, were included. Any such event that occurred in the index admission or within 30 days of discharge was included in the present study. Identification of AE's was based on the written records in case-sheet and analysis of the computer data. When clarification was required, the issue was discussed with involved physicians and nursing staff and the patient was contacted by telephone. Presence of one or more of the 12 predefined screening criteria constituted the screening process. Fifty three (10.83%) of 489 patients studied during the study period experienced a total of 101 AE's (20.65%). Majority of AE's occurred in trauma patients admitted from the emergency room--35 (66%)--and from the outpatient department (OPD)--30 (56.6%)--. Of the 101 AE's, 74 (73.1%) were estimated to have a high degree of preventability. On assessing the impact on patients, residual morbidity was noted in 1 (1.88%) patient. There was no mortality as a result of AE. AE's occurred due to non-adherence to existing protocols in totality. AE's resulted in increased morbidity of the patients, longer hospital stay, multiple surgeries and economic burden to the hospital. Identifying AE's provides the foundation and driving force for initiative to reduce morbidity. It also helps to evolve specific risk reduction strategies and self auditing and thereby improve quality care of patients.