Types and prevalence of adverse events among obstetric clients hospitalized in a secondary healthcare facility in Ghana

Abstract

Objective

The main objective of this study was to determine the types and prevalence of adverse events among obstetric clients hospitalized in a secondary health facility in Ghana.

Design

A retrospective study that reviewed medical records of obstetric clients on admission at the Obstetrics Unit of a secondary healthcare facility in Ghana.

Setting

Clinical environment. The study site is the third largest health facility in Ghana that provides maternity services and serves as the major referral facility for Greater Accra Region, the capital of Ghana. About 41% (4676) of its total antenatal cases (11,406) in 2015 were referrals from other facilities in Ghana. The medical records were reviewed retrospectively from 1 January to 31 December 2015. A four-stage review process was used: the first and second stages (by nurse/midwife reviewers) involved the identification and exclusion of records that had a length of stay less than 24 h and inadequate documentation; and were unlikely to include an adverse event. The third stage by obstetrician gynaecologist reviewers included a full review of all the positive trigger folders to determine the types, causes and degree of preventability of the adverse events. The fourth stage involved an independent obstetrician gynaecologist review of all records that had discrepancies. Details of the review process are presented in the figure.

Participants

Obstetric clients (i.e. pregnant women at any stage of gestation or less than 5 days after delivery who were attended to at the hospital). About a third (1402, 49.3%) met the inclusion criteria and were reviewed.

Main outcome measures

The main outcome measure for this study was the prevalence of adverse events among hospitalized obstetric clients.

Results

The prevalence of adverse events was 12% (168) out of 1402 records reviewed. The mean maternal age of the clients was 30.0 ± 5.8 years. Among these, the greatest proportion of adverse events was related to surgical interventions (66.3%) and the smallest were related to patient care (0.7%).

Conclusions

This study has provided the first documented prevalence (12.0%) and types of adverse events among hospitalized obstetric clients in a secondary health facility in Ghana. It provides a preliminary baseline for the burden of adverse events among the obstetric population in Ghana.

Keywords

Adverse events obstetric clients healthcare quality patient safety hospitalized

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References

Baker

Norton

Flintoft

et al. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. Can Med Assoc J 2004; 170: 1678–1686.

Stockwell

Bisarya

Classan

et al. A trigger tool to detect harm in pediatric inpatient settings. Pediatrics 2015; 135; 6.

Landrigan

Parry

Bones

et al. Temporal trends in rates of patient harm resulting from medical care – with comments. N Engl J Med 2010; 363: 2124–2134. 10.1056/NEJMsa1004404.

Magdelijns

FJH

Stassen

Stehouwer

CDA

et al. Direct health care costs of hospital admissions due to adverse events in the Netherlands. Eur J Public Health 2014; 24: 1028–1033. 10.1093/eurpub/cku037.

Brennan

Leape

Laird

et al. Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I. N Engl J Med 1991; 324: 370–376.

Hoogervorst-Schilp

Langelaan

Peter Spreeuwenberg

et al. Excess length of stay and economic consequences of AEs in Dutch hospital patients. BMC Health Serv Res 2015; 15: 531.

Rafter

Hickey

Condell

, et al. Review adverse events in healthcare: learning from mistakes. QJM 2015; 108: 273–277. 10.1093/qjmed/hcu145.

Walshe

Adverse events in healthcare: issues in measurement. Qual Health Care 2000; 9: 47–52.

Rafter

Hickey

Conroy

, et al. The Irish National Adverse Events Study (INAES): the frequency and nature of adverse events in Irish hospitals – a retrospective record review study. BMJ Qual Saf 2017; 26(2): 111-9

10.

Ennen

Satin

Reducing adverse obstetrical outcomes through safety sciences. 2016, https://www.uptodate.com/contents/reducing-adverse-obstetrical-outcomes-through-safety-sciences

11.

Lessing

Schimtz

Albers

et al. Impact of sample size on variation of adverse events and preventable adverse events. Qual Saf Health Care 2010; 19: 1–5. 10.1136/qshc.2008.031435.

12.

Neale

Woloshynowych

Vincent

Exploring the causes of adverse events in NHS hospital practice. J R Soc Med 2001; 94: 322–330.

13.

Vincent Neale

Woloshynowych

Adverse events in British hospitals: preliminary retrospective record review. BMJ 2001: 517–519.

14.

Zegers

Wagner

Hoonhout

et al. Adverse events and potentially preventable deaths in Dutch hospitals: results of a retrospective patient record review study. Qual Saf Health Care 2009; 297–302. DOI: 10.1136/qshc.2007.025924.

15.

Ansong-Tornui

Armar-Klemesu

Arhinful D, et al. Hospital based maternity care in Ghana – findings of a confidential enquiry into maternal deaths. Ghana Med J 2007; 41: 125–132.

16.

Florea

Caughey

Westland

et al. The Ottawa hospital quality incident notification system for capturing adverse events in obstetrics. J Obstet Gynaecol Can 2010; 32: 657–662. DOI: 10.1016/S1701-2163(16)34569-8.

17.

Twinjnstral ARH, Zeeman GG and Jansen FW. A novel approach to registration of adverse outcomes in obstetrics and gynaecology: a feasibility study. Qual Saf Health Care 2010; 19: 132--137. DOI: 10.1136/qshc.2008.030833

18.

Jha

Larizgoitia

Audera-Lopez

et al. The global burden of unsafe medical care analytic modelling of observational studies. BMJ Qual Saf 2012; 22: 809–15. DOI: 10.1136/bmjqs-2012-001748

19.

World Health Organization (WHO). International drug monitoring. The role of the hospital (WHO Technical Report Series No. 425), World Health Organization, Geneva, 1969.

20.

Elmontsri

Almashrafi

Banarsee

et al. Status of patient safety culture in Arab countries: a systematic review. BMJ Open 2017; 7. DOI: 10.1136/bmjopen-2016-013487.

21.

Zegers

Bruijne

de Wagner

et al. Design of a retrospective patient record study on the occurrence of adverse events among patients in Dutch hospitals. BMC Health Serv Res 2007; 7. DOI: 10.1186/1472-6963-7-27.

22.

Thomas

SDM

Burstin

Orav

et al. Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care 2000; 38: 261–271.

23.

Rutberg

Borgstedt-Risberg

Gustafson

, et al.

Adverse events in orthopedic care identified via the Global Trigger Tool in Sweden – implications on preventable prolonged hospitalizations.

Patient Saf Surg. 2016; 10: 23. DOI: 10.1186/s13037-016-0112-y.

24.

Davis

Lay-Yee

Briant

, et al. Adverse events in New Zealand public hospitals I: occurrence and impact. NZ Med J 2002; 115: 1–9. https://www.researchgate.net/publication/10930999

25.

Stevens

DP.

A systematic review: scholarly reports of in-hospital adverse event. Qual Saf Health Care. Epub ahead of print 2015.

26.

Aranaz-Andrés

Aibar-Remón

Limón-Ramírez

et al. Prevalence of adverse events in the hospitals of five Latin American countries: results of the “IberoAmerican Study of Adverse Events” (IBEAS). BMJ Qual Saf 2011; 20: 1043–1051. DOI: 10.1136/bmjqs.2011.051284.

27.

Groutz

Hasson

Wengier

et al. Third-and fourth-degree perineal tears: prevalence and risk factors in the third millennium. Am J Obstet Gynecol 2011; 204: 347.e1–4.

28.

Wilson

Runciman

Gibberd

et al. The Quality in Australian Health Care Study. Med J Aust 1995; 163: 458–471, https://www.researchgate.net/publication/13132921_The_Quality_in_Australian_Health_Care_Study_QAHCS--a_review.

29.

Smits

Zegers

Groenewegen

et al. Exploring the causes of adverse events in hospitals and potential prevention strategies. Qual Saf Health Care. 2010; 19: e5. DOI: 10.1136/qshc.2008.030726.