Prevalence of adverse events in the hospitals of five Latin American countries: results of the 'Iberoamerican Study of Adverse Events' (IBEAS).

BACKGROUND: Interest in patient safety (PS) is growing exponentially, fuelled by epidemiological research unveiling the extent of unsafe care. However, there is little information about the frequency of harm in developing and transitional countries. To address this issue, the authors performed a study known as the Iberoamerican Adverse Event Study, through a collaborative between the governments of Argentina, Colombia, Costa Rica, Mexico and Peru, the Spanish Ministry of Health, Social Policy and Equality, the Pan American Health Organization and the WHO Patient Safety. METHODS: The study used a cross-sectional design, involving 58 hospitals in the five Latin American countries, to measure the point prevalence of patients presenting an adverse event (AE) on the day of observation. All inpatients at the time of the study were included. RESULTS: A total of 11 379 inpatients were surveyed. Of these, 1191 had at least one AE that the reviewer judged to be related to the care received rather than to the underlying conditions. The estimated point prevalence rate was 10.5% (95% CI 9.91 to 11.04), with more than 28% of AE causing disability and another 6% associated with the death of the patient. Almost 60% of AE were considered preventable. CONCLUSIONS: The high rate of prevalent AE found suggests that PS may represent an important public-health issue in the participating hospitals. While new studies may be needed to confirm these results, these may already be useful to inspire new PS-improvement policies in those settings.

Diseño del estudio IBEAS: prevalencia de efectos adversos en hospitales de Latinoamérica / IBEAS design: adverse events prevalence in Latin American hospitals

Objetivos. Describir las características y metodología del estudio IBEAS: prevalencia de efectos adversos en hospitales de Latinoamérica, que persigue realizar una aproximación a la magnitud, trascendencia e impacto de los eventos adversos (EA); identificar áreas y problemas prioritarios de la seguridad del paciente; incrementar la masa crítica de profesionales involucrados en la seguridad del paciente e incorporar a la agenda de los países objetivos y actividades para mejorar la seguridad del paciente. Método. Estudio sobre la seguridad de los pacientes. Ámbito: 35 hospitales de 5 países: Argentina, Colombia, Costa Rica, México y Perú, a través del análisis de los efectos adversos identificados. Diseño de prevalencia utilizando la revisión de la historia clínica. Resultados. Se describen las implicaciones en el uso del diseño transversal en el estudio de EA, tanto en los recursos necesarios como en la validez interna y en la utilidad para la gestión de riesgos sanitarios. Conclusiones. El diseño transversal es eficiente en tiempo y recursos y fácil de realizar, y aunque no permite estudiar la totalidad del episodio de hospitalización, ha demostrado ser capaz para sostener un sistema de vigilancia. Debido a un posible sesgo de supervivencia, los EA que ocasionen un ingreso se verán sobrerrepresentados, y también aquellos relacionados con la infección nosocomial o los que sean difícilmente identificables si no se ve al paciente. La comunicación con el personal de planta (mientras el paciente está hospitalizado) favorece el juicio de la causalidad del efecto adverso y de su evitabilidad(AU)

Objectives. To describe the methodological characteristics of the IBEAS study: adverse events prevalence in Latin American hospitals, with the aim of analysing the magnitude, significance and impact of adverse events (AE); to identify the main problems associated with patient safety AE; to increase the capacity of professionals involved in patient safety; and the setting up of patient safety agendas in the participating countries. Methods. A patient safety study launched in 35 Latin American hospitals through the analysis of AE in 5 countries: Argentina, Colombia, Costa Rica, Mexico and Peru, using a cross-sectional study using a review of clinical records as the main method. Results. The implications of using a cross-sectional design when studying AE are described, in terms of resources required, internal validity and usefulness related to risk management. Conclusions. The cross-sectional design seems an efficient methodology in terms of time and resources spent, as well as being easy to carry out. Although the cross-sectional design does not review the all hospital episodes, it is able to provide a reliable estimate of prevalence and to support a surveillance system. Because of a possible survival bias, it is likely that the AE which led to hospital admissions will be overestimated, as well as the health related infections or those adverse events which are difficult to identify if the patient is not examined (e.g. contusions). Communication with the ward staff (if the patient is still hospitalised) help in finding the causality and their prevention(AU)

[IBEAS design: adverse events prevalence in Latin American hospitals]. / Diseño del estudio IBEAS: prevalencia de efectos adversos en hospitales de Latinoamérica.

OBJECTIVES: To describe the methodological characteristics of the IBEAS study: adverse events prevalence in Latin American hospitals, with the aim of analysing the magnitude, significance and impact of adverse events (AE); to identify the main problems associated with patient safety AE; to increase the capacity of professionals involved in patient safety; and the setting up of patient safety agendas in the participating countries. METHODS: A patient safety study launched in 35 Latin American hospitals through the analysis of AE in 5 countries: Argentina, Colombia, Costa Rica, Mexico and Peru, using a cross-sectional study using a review of clinical records as the main method. RESULTS: The implications of using a cross-sectional design when studying AE are described, in terms of resources required, internal validity and usefulness related to risk management. CONCLUSIONS: The cross-sectional design seems an efficient methodology in terms of time and resources spent, as well as being easy to carry out. Although the cross-sectional design does not review the all hospital episodes, it is able to provide a reliable estimate of prevalence and to support a surveillance system. Because of a possible survival bias, it is likely that the AE which led to hospital admissions will be overestimated, as well as the health related infections or those adverse events which are difficult to identify if the patient is not examined (e.g. contusions). Communication with the ward staff (if the patient is still hospitalised) help in finding the causality and their prevention.