Adverse events related to Spanish hospital emergency department care: the EVADUR study

Tomás Vecina S, Chanovas Borràs M, Roqueta F, Alcaraz J, Toranzo Cepeda T

Objectives: 1) To determine the type and incidence of adverse events (AE), analyzing

reasons, avoidability, and repercussions in patients treated in Spanish hospital

emergency departments (ED); 2) to determine the percentage of visits to ED that are

related to AE that occurred after earlier hospital or out-of-hospital emergency treatment

(an AE related to a previous episode); 3) to assess the predictive value of a screening tool

used in hospital emergency departments.

Method: Prospective, multicenter, descriptive, follow-up study in 21 Spanish hospital

ED. On 7 different days (each corresponding to a day of the week) between October

and December 2009, investigators followed the case management of randomly selected

patients in real time (24 hours) to gather information on AE. Each event was later

analyzed by an independent committee. To detect possible late-developing adverse

events, case information was also gathered 7 days after a patient?s discharge from the

ED. The data collection tools were validated and interrater agreement was assessed

before the study began.

Results: In the sample of 3854 cases studied, 462 (12) involved at least 1 incident or AE 505

incidents or AE (1.03/patient; 0.18/visit) were detected. Of these, 44 (1.1%) incidents did

not lead to error in patient care; 184 (4.9%) did affect patient care but caused no harm; and

277 (7.2%) led to injury. A total of 217 (43%) incidents or AE were detected after discharge,

on follow-up. Both extrinsic and intrinsic factors were found to be correlated with events. In

54.8% of the cases, the treatment process was unaffected. Seventy percent of the detected

events could have been avoided; in 54.6% there was evidence of error. Mortality related to

an adverse event was 0.05%. Only 17% of the incidents or AE were noted in the medical

record; 7.5% of the ED visits were attributable to a previous AE. Additional medication or

procedure requirements were the most frequent repercussions. The reasons for events were

most often related to aspects of care, medication, diagnosis, or communication and these

factors proved to be independent predictors of risk.

Conclusions: Twelve percent of patients treated in Spanish hospital ED experience some

type of care incident or adverse event. Many (70%) of the events could be avoided and

follow-up measures to prevent them should be established.

Alcaraz J, Chanovas Borràs M, Roqueta F, Tomás Vecina S, Toranzo Cepeda T