Adverse events in British hospitals

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7299.1425 (Published 09 June 2001) Cite this as: BMJ 2001;322:1425

Preventive strategies, not epidemiological studies, are needed

  1. Tuan V Nguyen (t.v.nguyen@unsw.edu.au), senior fellow,
  2. Ken M Hillman, professor,
  3. Michael D Buist, director
  1. Simpson Centre for Health Services Research, Liverpool Hospital, Liverpool, New South Wales 2170, Australia
  2. Intensive Care Unit, Dandenong Hospital, Dandenong, Victoria 3175, Australia
  3. Ninewells Hospital and Medical School, Dundee DD1 9SY
  4. Bradford Hospitals NHS Trust, Bradford BD9 6RJ
  5. Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WCIE 7HT
  6. Royal Free and University College Medical School, Department of Primary Care and Population Sciences, London N19 3UA
  7. Central Public Health Laboratory, London NW9 5HT
  8. Centre for the Study of Clinical Practice, Fitzroy, Victoria 3065, Australia cqm@sprint.net.au
  9. Mayday Healthcare NHS Trust, Thornton Heath, Surrey CR7 7YE
  10. Clinical Risk Unit, Department of Psychology, University College London, London WC1E 6BT
  11. West Midlands Centre for Adverse Drug Reaction Reporting, City Hospital, Birmingham B18 7QH
  12. Department of Clinical Pharmacology, Radcliffe Infirmary, Oxford OX2 6HE
  13. Department of Health Services, School of Public Health and Community Medicine, Box 357660, University of Washington, Seattle, WA 98195-3576, USA

    EDITOR—Vincent et al estimated that about 11% of hospital admissions in two hospitals were associated with an adverse event and argue for a larger study to document the prevalence of such adverse events in the United Kingdom.1 Their estimate of adverse events occurring in hospital is well within the statistical boundary of previous estimates obtained by much larger studies in the United States2 and Australia3; their argument for yet another large study therefore seems weak. Sufficient evidence already exists; there is an urgent need now for strategies to prevent or reduce the error, not for another descriptive epidemiological study.

    Death, cardiac arrest, and unplanned admissions to an intensive care unit are probably the most serious among the adverse events. Most of these events have their genesis in general wards; they are not sudden or unpredictable, because they are usually preceded by signs of clinical instability. Because of this, medical emergency teams have been developed and tested.4

    The system has three components: identifying high risk patients at an early stage; providing a rapid response; and providing feedback data on the effectiveness of the medical emergency team. Under this system, when a patient's clinical condition is unstable (as judged by specific criteria) a call is immediately made to the team for intervention. We postulate that the system is an effective strategy to reduce adverse events occurring in hospital.

    In a prospective study conducted in a 300 bed tertiary referral teaching hospital in Melbourne, after the medical emergency team system was implemented the incidence of cardiac arrest was halved (unpublished data). Moreover, in a six month prospective study the incidence of cardiac arrest, deaths, and unplanned admissions to the intensive care unit in one hospital with a medical emergency team was lower than the incidence in two hospitals …

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