Setting priorities for patient safety
Open accessAbstract
BACKGROUND: Current "flags" for adverse events (AEs) are biased towards those with serious outcomes, potentially leading to failure to address mundane common problems. AIM: To provide a basis for setting priorities to improve patient safety by ranking adverse events by resource consumption as well as by outcome. This was done by classifying a set of AEs, according to how they may be prevented, into "Principal Natural Categories" (PNCs). SETTING: AEs associated with a representative sample of admissions to Australian acute care hospitals. DESIGN: AEs were classified into PNCs which were ranked by overall frequency, an index of resource consumption (a function of mean extended hospital stay and the number of cases in each PNC), and severity of outcome. RESULTS: The 1712 AEs analysed fell into 581 PNCs; only 28% had more than two cases. Most resource use (60%) was by AEs which led to minor disabilities, 36% was by those which led to major disabilities, and 4% by those associated with death. Most of the events with serious outcomes fell into fewer than 50 PNCs; only seven of these PNCs had more than six cases resulting in serious outcomes. CONCLUSIONS: If interventions for AEs are triggered only by serious outcomes by, for example, using recommended risk scoring methods, most problems would not be addressed, particularly the large number of mundane problems which consume the majority of resources. Both serious and mundane problems should be addressed. Most types of events occur too infrequently to be characterised at a hospital level and require large scale (preferably national) collections of incidents and events.
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Computer-related incidents account for about 60% of incident-related resource consumption.
“Nevertheless, they account for about 60% of incident-related resource consumption.30”
From An analysis of computer-related patient safety incidents to inform the development of a classification (2010) · cites this paper as [30]
Identifying the natural categories of safety incidents has been the method used for creating the AIMS classification, which is the starting point for expanding the ICPS.
“Identifying the natural categories of safety incidents has been the method used for creating the AIMS classification, which is the starting point for expanding the ICPS.18 30”
From An analysis of computer-related patient safety incidents to inform the development of a classification (2010) · cites this paper as [30]
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Flagged first, then by citations
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Self-citation
- Authors
- Runciman, W. B.
- Affiliations
- Royal Adelaide Hospital (AU)
- Corresponding author
- Runciman, W B
- ORCID
- Runciman, W B
- Venue
- Quality and Safety in Health Care
- Publisher
- BMJ
- Published
- 2002-09-01
- Volume
- 11
- Issue
- 3
- Pages
- 224-229
- ISSN
- 1475-3898 (ISSN-L)
- 1475-3901
- PMC
- PMC1743639
- OpenAlex
- W2115473915
- Cited by
- 77
- References
- 15
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 3 · 2020: 2 · 2019: 4 · 2017: 2 · 2016: 1 · 2015: 8 · 2014: 2 · 2013: 6 · 2012: 4
- FWCI
- 7.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ Quality & Safety (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Topics
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Keywords
- patient safety, adverse events, priority setting, resource consumption, adverse event classification, length of hospital stay, outcome severity, risk scoring, incident reporting, acute care hospitals
- MeSH terms
- Australia, Health Priorities, Hospital Administration, Humans, Iatrogenic Disease, Quality Assurance, Health Care, Health Care Rationing, Hospital Mortality, Outcome Assessment, Health Care, Safety Management, Risk Assessment, Medical Errors
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