Patient Reports May Lead to Fewer Adverse Events

Improvement of patient safety relies on incident reports, automated surveillance of clinical data, and review of medical records, but according to a group of Massachusetts researchers, patient surveys can also provide important information. This study was reported today in the Annals of Internal Medicine. 

Through the study the researchers found that when surveyed, nearly 23 percent of patients reported a complication during or immediately after their treatment, whereas the adverse events of only about 11 percent were identified through medical record review.

Every approach to monitoring adverse events is limited, but patient surveys can help, said lead author Joel Weissman, PhD, of the Massachusetts General Hospital Institute for Health Policy.

"Our research demonstrates that patients themselves can be a valuable source of information about unexpected complications that occur as a result of medical care, both during their hospital stay and after they are discharged," Weissman said.

While many healthcare facilities regularly survey patients after discharge, those surveys are usually focused on patients' satisfaction with their care and not on whether they experienced injuries or complications.

The current study was designed to evaluate whether patients can accurately report adverse events they experienced, the types of events patients were most likely to report and how well patient reports matched what was in the medical record. It consisted of two primary phases: a telephone survey of patients admitted to 16 Massachusetts hospitals during six months in 2003 and a review of the medical records of survey participants who gave written permission for the review.

About 2,600 patients participated in the telephone survey, which took place 6 to 12 months after hospital discharge. The 20-minute interview assessed several aspects of clinical care and specifically asked about any negative effects, complications or injuries they had experienced during or after their hospitalization. Events patients reported were subsequently reviewed by two physician co-authors, who evaluated and scored them by severity and preventability.

Medical records review, approved by almost 1,000 patients, was conducted by nurses trained to identify adverse events according to specific criteria. Two different physician reviewers classified and scored the medical record events.

The study identified 381 patients who experienced some sort of adverse event — 229 were identified in the interview and 105 in the medical record, but only 53 were noted by both sources. Less than 10 percent of events identified by either method were serious or life-threatening, and under a third were determined to be probably or definitely preventable. Most of the events that took place after patients were discharged from the hospital were related to their care but did not become evident until they left the hospital.

According to Saul Weingart, MD, PhD, of Dana-Farber Cancer Institute, a study co-author and one of the physicians who reviewed patient-reported events, "We need to learn more about how patients can help clinicians ensure safe care in the hospital and in ambulatory settings. It's pretty clear that they can teach us important things about improving patient safety, if we only ask them."

While conducting the kind of telephone surveys used in this study might be costly, the researchers note, so is medical record review. Adding safety-oriented questions to existing satisfaction-focused patient questionnaires might be a first step, but utilizing multiple methods to track adverse events will probably give the most accurate results.

Source: Massachusetts General Hospital