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Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis

BMJ 2019; 366 doi: (Published 17 July 2019) Cite this as: BMJ 2019;366:l4185

Linked editorial

Preventable harm: getting the measure right

Rapid Response:

Are anesthesia settings equally important in terms of preventable patient harm?

Herewith, we thank Panagioti and colleagues for their tremendous work on pooled analyses of the prevalence, severity, and nature of preventable patient harm in different medical settings.[1] This topic is of heightened interest to all clinical health professionals, especially we anesthesiologists. However, we express deep concern about the accuracy based on the principles of performing a meta-analysis.

One crucial finding of this study was that preventable patient harm was more prevalent in advanced specialties (intensive care or surgery) which may entail high-risk patients and more work pressures. We do agree with these convincible explanations. However, we cannot accept the notion that “Surgery” can stand for “Anesthesia”, though we anesthesiologists are always suffering more work overload or even sudden death than our counterparts.2 Even if “Surgery” encompasses the anesthesia setting, it seems that the authors may have missed some articles focusing on anesthesia-associated patient harm according to the inclusion criteria.3-5 Particularly, taking into account the important principle of comprehensive data collection when performing a meta-analysis, missing some articles might have an impact on pooled effects and sometimes the results can even go in the contrary direction.

In addition, the choice of the model involved seems to be inappropriate. Generally speaking, the model is selected based on the heterogeneity. If the I2 > 50% was considered indicative of statistical heterogeneity, in which case the random-effects model would be adopted, otherwise a fixed-effects model would be considered.

Overall, we suggest the authors could include anesthesia-associated preventable patient harm, which is a crucial part and dates back to the 1970s.

1 Panagioti M, Khan K, Keers RN, et al. Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis. BMJ 2019; 366: l4185. doi: 10.1136/bmj.l4185
2 Huang J, Lee J. Causes of sudden death of young anesthesiologists in China: Response to Zhang and colleagues: Rising sudden death among anaethesiologists in China. Br J Anaesth 2017; 119: 548-549. doi: 10.1093/bja/aex288
3 Curatolo CJ, McCormick PJ, Hyman JB, Beilin Y. Preventable Anesthesia-Related Adverse Events at a Large Tertiary Care Center: A Nine-Year Retrospective Analysis. Jt Comm J Qual Patient Saf 2018; 44: 708-718. doi: 10.1016/j.jcjq.2018.03.013
4 Wanderer JP, Gratch DM, Jacques PS, Rodriquez LI, Epstein RH. Trends in the Prevalence of Intraoperative Adverse Events at Two Academic Hospitals After Implementation of a Mandatory Reporting System. Anesth Analg 2018; 126: 134-140. doi: 10.1213/ANE.0000000000002447
5 Lobaugh L, Martin LD, Schleelein LE, Tyler DC, Litman RS. Medication Errors in Pediatric Anesthesia: A Report From the Wake Up Safe Quality Improvement Initiative. Anesth Analg 2017; 125: 936-942. doi: 10.1213/ANE.0000000000002279

Competing interests: No competing interests

23 July 2019
Liang Sun
Attending Anesthesiologist
Yi Feng
Peking Universtiy People's Hospital
No.11 Xizhimen South Street, Xicheng District, Beijing 100044, China