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Dutch study shows that 40% of adverse incidents in hospital are avoidable

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39199.498137.DB (Published 03 May 2007) Cite this as: BMJ 2007;334:925
  1. Tony Sheldon
  1. Utrecht

    Each year about 30 000 hospital patients in the Netherlands suffer avoidable harm during treatment, a new national study has estimated. About 1700 deaths a year could be avoided, it says.

    The independent investigation was initiated by the Dutch hospital consultants' body, the Order of Medical Specialists (Orde van Medisch Specialisten), and had the cooperation of a cross section of the country's hospitals. Pieter Vierhout, a surgeon and chairman of the body, said that the Netherlands may compare favourably with other countries in terms of safety but that “every avoidable death or patient harmed is one too many.”

    The report—by the order, the Institute for Health Services Research, and Amsterdam's Free University Medical Centre—showed that 5.7% of patients in 1.3 million hospital admissions in 2004 suffered unintentional harm (an adverse event). Worldwide this percentage ranges from 2.9% to 16.6%, says the US Institute of Medicine's 1999 report To Err is Human:Building a Safer Health System.

    However, about 40% of these adverse events in the Netherlands were deemed avoidable. About 6000 patients a year suffered some form of permanent harm as a result of the adverse events, the report said.

    Researchers had access to 8000 patients' files in 21 Dutch hospitals (about a quarter of the total), including a range of university, specialist clinical, and general units. More than 120 nurses and hospital consultants studied the files to identify clues such as unexpected deaths and readmissions and to judge whether harm could have been avoided.

    Examples of adverse events included postoperative bleeding requiring further surgery and unexpected allergic reactions to treatment. Avoidable adverse events included drug treatment errors on discharge from hospital that resulted in the patient's readmission and failure to diagnose a leaking suture after abdominal surgery, leading to sepsis and death.

    The researchers argue that adverse events often result from the complexity of modern care, especially care of elderly patients. Deaths, however, are often the result of largely preventable mistakes in diagnosis. They conclude: “In some situations harm can be put down to the risk of treatment itself but in other cases can be traced back to unsatisfactory treatment according to professional standards and shortcomings in the system of care.”

    Their recommendations include real time monitoring of outcomes; systematic analysis of all deaths by consultants from a range of different specialties; identification of weak departments by medical staff and hospital boards; and standardisation of electronic patients' records.

    Dr Vierhout said, “The Netherlands could become an examplar of good practice within Europe.” However, he added that firstly there needed to be “a cultural change within our hospitals—we need to be more critical and more disciplined.”

    The Dutch health minister, Ab Klink, said in an emergency parliamentary debate last week that the situation could no longer be tolerated and that an action plan to improve hospital safety will be launched in June.

    Footnotes

    • Onbedoelde Schade in Nederlandse Ziekenhuizen (Adverse Events in Dutch Hospitals) is available at www.nivel.nl.

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