Adverse events related to Spanish hospital emergency department care: the EVADUR study

Objectives: 1) To determine the type and incidence of adverse events (AE), analyzing reasons, avoidability, and repercussions in patients treated in Spanish hospital emergency departments (ED); 2) to determine the percentage of visits to ED that are related to AE that occurred after earlier hospital or out-of-hospital emergency treatment (an AE related to a previous episode); 3) to assess the predictive value of a screening tool used in hospital emergency departments. Material and methods: Prospective, multicenter, descriptive, follow-up study in 21 Spanish hospital ED. On 7 different days (each corresponding to a day of the week) between October and December 2009, investigators followed the case management of randomly selected patients in real time (24 hours) to gather information on AE. Each event was later analyzed by an independent committee. To detect possible late-developing adverse events, case information was also gathered 7 days after a patient's discharge from the ED. The data collection tools were validated and interrater agreement was assessed before the study began. Results: In the sample of 3854 cases studied, 462 (12) involved at least 1 incident or AE 505 incidents or AE (1.03/patient; 0.18/visit) were detected. Of these, 44 (1.1%) incidents did not lead to error in patient care; 184 (4.9%) did affect patient care but caused no harm; and 277 (7.2%) led to injury. A total of 217 (43%) incidents or AE were detected after discharge, on follow-up. Both extrinsic and intrinsic factors were found to be correlated with events. In 54.8% of the cases, the treatment process was unaffected. Seventy percent of the detected events could have been avoided; in 54.6% there was evidence of error. Mortality related to an adverse event was 0.05%. Only 17% of the incidents or AE were noted in the medical record; 7.5% of the ED visits were attributable to a previous AE. Additional medication or procedure requirements were the most frequent repercussions. The reasons for events were most often related to aspects of care, medication, diagnosis, or communication and these factors proved to be independent predictors of risk. Conclusions: Twelve percent of patients treated in Spanish hospital ED experience some type of care incident or adverse event. Many (70%) of the events could be avoided and follow-up measures to prevent them should be established. [Emergencias 2010;22:00-00]