Adverse patient occurrences in a university hospital: a comparison of screening results registered by specialists and by external review.

A quality assurance system for generic screening of patient care has been developed in a university hospital in The Netherlands. This system is based on the Medical Management Analysis System, developed in the United States. Patient care is systematically screened for adverse patient occurrences (APOs). Screening criteria have been developed and some adjustments have been made to the original system, because of structural differences in health care between the United States and The Netherlands. The results of a study comparing two screening strategies are presented: screening by a medically trained, outside reviewer and screening by the Ear, Nose and Throat specialists themselves. The reviewer screened almost all admissions to the department as opposed to the specialist, who filled in screening forms of only 77.5% of the admissions. Specialists are found to register more APOs in their own domain (42%) as compared to the screener (28%). Issues concerning the nursing process receive less attention by the specialists (14%) than by the screener (22%). Because the personnel delivering direct patient care are more familiar with and informed about this process of care, the importance is stressed of getting specialists as well as nurses involved in the evaluation of the care they deliver to patients.

Registration of adverse patient occurrences in a university hospital: relations between adverse patient occurrences and characteristics of hospitalized patients.

This paper reports the results of a survey on adverse patient occurrences (APOs) in patient care in a university hospital in The Netherlands. Screening for APOs is important as an instrument of quality assurance. Results from 1 year of screening have been related to specific patient characteristics. Age, length of stay and diagnosis group are strongly related to the identified APOs. The chances of APOs are very high if the patient belongs to certain diagnosis groups (operation procedure salivary gland, malignant disorder ear, nose, throat) and at the same time has a long length of stay in the hospital. The chances of being afflicted with more than one APO are strongly related to age and length of stay. With regard to the types of APO, this study shows a relation between patient characteristics and some APOs, but the statistical significance or the nature of these relations varies with type.