Healthcare processes must be improved to reduce the occurrence of orthopaedic adverse events

Scand J Caring Sci; 2010; 24; 671–677Healthcare processes must be improved to reduce theoccurrence of orthopaedic adverse eventsBackground: Many nonhealth industries have decades ofexperiences working with safety systems. Similar systemsare also needed in healthcare to improve patient safety.Clinical incident reporting systems in healthcare identifyadverse events but seriously underestimate the incidenceof adverse events. A wide range of information sources andmonitoring techniques are needed to understand andmitigate healthcare risks.Aim: The purpose of this study was to identify patientsafety risk factors that can lead to adverse events in adultorthopaedic inpatients.Design: A three-stage structured retrospective patientrecord review of consecutively admitted patients to theinpatient service of a large, urban Swedish hospital.Method: Records for all orthopaedic inpatients admittedduring a 2-month period (n = 395) were screened using 12criteria. Positive records were then reviewed in two stagesby orthopaedic surgeons using a standardized protocol.Data were collected from the index admission andfrom subsequent visits or readmissions within 28 days ofdischarge.Results: Sixty patients experienced 65 healthcare associatedadverse events. Affected patients had a length of hospitalstay double that of patients without adverse events.Adverse events were more common in patients undergo-ing surgical procedures and patients with risk factors foranaesthesia. Although 59 of the adverse events occurred inpatients who underwent surgery, only nine of the adverseevents were due to deficiencies in surgical/anaesthesiatechnique. The others were related to deficiencies inhealthcare processes. The most common adverse eventswere hospital acquired infections (n = 20) and delayeddetection of urinary retention (n = 13). Six adverse drugevents involved elderly patients (‡65 years).Conclusion: Orthopaedic care is a high risk activity for itstypically elderly, often debilitated patients. Reducingadverse events in orthopaedic patients will require moremultidisciplinary, interdepartmental teamwork strategiesthat focus on healthcare processes outside the operatingroom.Keywords: adverse events, orthopaedic care, retrospectiverecord review, patient safety, risk factors, healthcareprocesses, teamwork, nursing.Submitted 5 January 2009, Accepted 7 October 2009