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Study of a multisite prospective adverse event surveillance system.

Alan J Forster1,2, Allen Huang3, Todd C Lee4,5

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Prospective adverse event (AE) surveillance can be implemented across hospitals. However, observed AE rate variations may stem from patient populations or surveillance methods, not just hospital safety.

Keywords:
adverse events, epidemiology and detectionpatient safetytrigger tools

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Area of Science:

  • Healthcare quality improvement
  • Patient safety research
  • Clinical surveillance methodologies

Background:

  • A novel prospective adverse event (AE) surveillance method was developed.
  • The study aimed to assess the performance of this AE surveillance method across multiple hospital settings simultaneously.

Purpose of the Study:

  • To compare adverse event (AE) rates identified through prospective surveillance in different hospitals.
  • To evaluate potential measurement factors contributing to observed variations in AE rates between institutions.

Main Methods:

  • A multicenter prospective observational study was conducted over 8 weeks.
  • Prospective AE surveillance was implemented on general medicine wards in five hospitals.
  • Mixed-effects logistic regression analyzed population factors; observer reassignment and event reallocation assessed surveillance factors.

Main Results:

  • 356 AEs were identified across 3560 patient days (22% AE risk per encounter).
  • AE risk varied significantly between hospitals (9.9% to 35.8%), despite similar AE types and severity.
  • Observed hospital-level differences in AE risk were associated with patient demographics and potentially influenced by observer variability and reviewer agreement.

Conclusions:

  • Prospective surveillance is feasible in diverse healthcare settings.
  • The method is more suitable for evaluating intra-hospital safety than inter-hospital comparisons due to unresolved population and surveillance factor influences.
  • Further research is needed to differentiate AE rate variations attributed to patient populations versus surveillance system dynamics.