Adverse events in British hospitals: preliminary retrospective record review

Dear Sir,

Re: Adverse events in British hospitals: preliminary retrospective
record review. BMJ, 322; 517-519

The authors of a recent paper commented that 'the epidemiology of
adverse events has not been studied in Britain.'1 Neither the paper or
the additional information on the BMJ Website provides detailed
information on what constitutes an adverse event. However, it would
appear from the example given, that hospital-acquired infections (HAIs)
are included in this category. Assuming this to be the case, it would
have been interesting to know whether all HAIs were classified as adverse
events caused by medical management, or whether some infections were
excluded because they were viewed as unfortunate consequences of the
disease process. If all HAIs were included in this category then there is
information on both the epidemiology of this particular adverse event,2
and the economic burden imposed.3

The paper reports that 46% of the adverse events identified were
judged preventable, and that preventable events cost the NHS around £1bn
per year in terms of additional bed days.1 It would be interesting to
know what proportion of these preventable events were HAIs and how this
judgement was made. Recent subjective estimates suggest that 15% of HAIs
could be prevented through improvements in infection control,4 earlier but
more objective data suggests that it might be twice this figure.5 If 15%
were prevented then, based on the results of recent estimates of the
economic burden of HAIs, the prevention of this type of adverse event
alone would result in the release of at least 546,000 bed days and
resources valued at £150 million. These estimates are limited to HAIs
occurring in adult non-day case patients admitted to selected specialties
of NHS Hospitals in England (approximately 70% of adult non-day case
admissions).3 The overall number of bed days and resources released from
the prevention of this type of adverse event is therefore likely to be
considerably higher.

1. Vincent C, Neale G, Woloshynowych M. Adverse events in British
hospitals: preliminary retrospective record review. BMJ 2001;322:517-519.

2. Emmerson AM, Entstone J, Griffin M, Kelsey MC, Smyth ETM. The
second national prevalence survey of infection in hospitals - Overview of
the results. J. Hosp Infect 1996(32):175-190.

3. Plowman R, Graves N, Griffin M, Roberts JA, Swan AV, Cookson B,
et al. The rate and cost of hospital acquired infections occurring in
patients admitted to selected specialties of a district general hospital
in England and the national burden imposed. J Hosp Infect 2001;47(3):198-
209.

4. Report of the Comptroller and Auditor General. The Management and
Control of Hospital Acquired Infection in Acute NHS Trusts in England.
London: The Stationary Office Limited, 2000.

5. Haley RW. Managing hospital infection control for cost-effectiveness:
a strategy for reducing infectious complications. Chicargo: American
Hospital Publishing, 1986.

Rosalind Plowman

Lecturer

Department of Public Health and Policy,
London School of Hygiene and Tropical Medicine,
Keppel Street,
London WCIE 7HT


Email: R.plowman@ lshtm.ac.uk

Jennifer A Roberts,

Reader in the Economics of Public Health

Department of Public Health and Policy,
London School of Hygiene and Tropical Medicine,
Keppel Street,
London WCIE 7HT

Nicholas Graves,

Lecturer,

Department of Public Health and Policy,
London School of Hygiene and Tropical Medicine,
Keppel Street,
London WCIE 7HT

Mark A S Griffin

Lecturer in Medical Statistics

Royal Free & University College Medical School,
Department of Primary Care & Population Sciences,
Level 2,
Archway Campus,
Holborn Union Building,
Highgate Hill,
London N19 3UA

Barry Cookson,

Director of the Laboratory of Hospital Infection,

Central Public Health Laboratory,
61, Colindale Avenue,
London NW9 5HT

Lynda Taylor

Head of Infection Control Unit,

Central Public Health Laboratory,
61, Colindale Avenue,
London NW9 5HT