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Cited by 874Patient Safety and Medication ErrorsMedical Malpractice and Liability IssuesClinical Reasoning and Diagnostic Skills

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

Open access
Panagioti, Maria, Khan, Kanza, Keers, Richard N, Abuzour, Aseel, Phipps, Denham, Kontopantelis, Evangelos, Bower, Peter, Campbell, Stephen +3 more·2019·BMJ
DOI 10.1136/bmj.l4185PMC PMC6939648
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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 I 2 statistic, and publication bias was evaluated. Results: Of the 7313 records identified, 70 studies involving 337 025 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.

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  • Internationally, the pooled rate of hospital harm is 6% of patients across medical settings.

    “Internationally, the pooled rate of hospital harm is 6% of patients across medical settings [36].”

    From The hospital-to-home care transition experience of home care clients: an exploratory study using patient journey mapping (2023) · cites this paper as [36]

    The Results report a pooled prevalence of 6% for preventable patient harm across medical care settings, not for all hospital harm. Table 1 gives 5% for preventable harm in hospitals specifically and 12% for overall harm across settings. (LLM, conf=0.90)

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Research works printed but not linked: 1

  1. [69]Mayor S Baines E Vincent C Health Services and Delivery Research. Measuring harm and informing quality improvement in the Welsh NHS: the longitudinal Welsh national adverse events study. NIHR Journals Library, 2017. 28252896

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Authors
Panagioti, M., Khan, K., Keers, R. N., Abuzour, A., Phipps, D., Kontopantelis, E., Bower, P., Campbell, S., Haneef, R., Avery, A. J., & Ashcroft, D. M.
Affiliations
  • University of Manchester (GB)
  • Lancashire Teaching Hospitals NHS Foundation Trust (GB)
  • University of Nottingham (GB)
Corresponding author
Panagioti, Maria
ORCID
Venue
BMJ
Publisher
BMJ
Published
2019-07-17
Volume
366
Pages
l4185
ISSN
  • 1756-1833 (ISSN-L)
  • 0959-8138
DOI
10.1136/bmj.l4185
PMC
PMC6939648
OpenAlex
W2958795513
Cited by
874
References
129
Citations by year
2026: 116 · 2025: 158 · 2024: 155 · 2023: 137 · 2022: 99 · 2021: 114 · 2020: 81 · 2019: 12 · 2018: 1
FWCI
19.97
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Repository@Nottingham (University of Nottingham) (publishedVersion, cc-by-nc)
  • Research Explorer (The University of Manchester) (publishedVersion, cc-by-nc)
  • Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by-nc)
  • Uppsala University Publications (Uppsala University) (submittedVersion, other-oa)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • National Institute for Health and Care Research (GMPSTRC-2012-1)
  • NIHR Greater Manchester Patient Safety Translational Research Centre (GMPSTRC-2012-1)
  • NIHR School for Primary Care Research
Topics
  • Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
  • Health Sciences › Health Professions › Pharmacy › Medical Malpractice and Liability Issues
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
Keywords
preventable patient harm, patient safety, medical errors, drug-related harm, harm severity, hospital care, intensive care, surgical care, quality of care
MeSH terms
Cross-Sectional Studies, Humans, Retrospective Studies, Severity of Illness Index, Prevalence, Evidence-Based Practice, Quality Improvement, Patient Safety, Patient Harm, Observational Studies as Topic

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