A study of adverse events in Chinese hospitals

Adverse events (AEs) have negative impacts on patients, and may sometimes cause severe harm to patients and even death. This thesis aimed to investigate AEs in Chinese hospitals. Two studies had been designed and conducted in order to meet the aim. The first study, a systematic review, was designed to collect relevant evidence about the prevalence, consequence, classifications of AEs in the past 7 years. Seven studies were included in the systematic review, which were sub-grouped to studies carried out in developed countries and developing countries. The research conducted in developed countries identified higher prevalence rates of AEs than in developing countries, but a higher proportion of AEs were considered to be preventable in developing countries. In addition, higher proportion of AEs in developing countries were found to cause patient mortality. The review showed that no studies measured AEs in China from a hospital-wide level. The second study of this thesis aimed to determine the prevalence, preventability, consequence and risk factors of AEs in Chinese hospitals. A medical record audit was conducted based on a two-stage retrospective medical records review protocol. In total, the records of 1,897 patients were randomly selected from two Chinese hospitals. Both of the hospitals were public secondary-level hospitals, located in a major city in China, with around 550 beds in each hospital. Each medical record was screened by a nurse according to 17 explicit screening criteria. If one or more criteria were satisfied, the medical record was forwarded to a panel of doctors for further review. Two doctors reviewed each medical record independently. There were 16 nurses involved in screening process and 40 doctors participated in the review process. The medical records were screened by nurses, with a screening positive rate of 10.6% (9.3%-12.1%, 95% CI). Older patients (≥65 years) who were admitted to non-surgical departments and stayed in hospital longer than 14 days had more risk of being screened as positive for AEs. After review by doctors, the review positive rate (prevalence) of AEs was dramatically reduced to 1.14% (0.69%-1.68%, 95% CI). Surprisingly, all the AEs were judged as preventable by doctors, and 85% were highly preventable. Forty percent of detected AEs caused temporary disability to patients, but no permanent disability or deaths caused by AEs were found based on doctors’ judgments. Patients with longer hospital stays, in particular longer than 24 days, had more risk to be judged as AEs case by doctors. The unexpectedly low screening positive rate and review positive rate (prevalence) of AEs based on the nurses’ and doctors’ decisions were found to be remarkably lower than previous studies. The results may have been significantly influenced by the quality of medical records in China. However it is very likely that the reviewers’ judgments, especially the doctors’, had a major impact on the study results. The results generated by the nurses in the screening process were considered to be more credible and consistent with other studies. The thesis concludes with a discussion of the implications of the study findings for future policy and practice in Chinese hospitals as well as the implications for future research in this area. From policy and practice level, the implications include establishment of governance for patient safety, nurses’ crucial role on reduction of AEs, improvement of the quality of medical record, and protection of healthcare professionals’ safety. From the research level, this thesis could be a base study for further exploration on methodologies about detection of AEs and localised screening criteria. In addition, more and upgraded training is recommended for future medical record audit study.