Detecting and reducing adverse events in an Australian rural base hospital emergency department using medical record screening and review

Objective: To determine if retrospective medical record screening and clinical review Followed by appropriate action can effectively and efficiently detect and reduce adverse events in an emergency department. Method and participants: The medical records of 20 050 patients who attended the emergency department over a two year period were screened for adverse events using five general patient outcome criteria. Records that screened positive were reviewed by the hospital's clinical risk manager. If an adverse event was detected, the record was also reviewed by the director of emergency. For the first three months details of adverse events were recorded to determine a baseline adverse event rate, but no further action was taken, When an adverse event was found in the remaining 2 1 months, further analysis and recommendations for action to prevent a recurrence were made to relevant hospital staff. Setting: A rural base hospital in the Wimmera region of Victoria, Australia between October 1997 and September 1999. Results: Of all the patient attendances 573 (2.85%) were screened positive for one or more criteria. An adverse event was confirmed in 250 patient attendances (1.24% of all attendances). Of the adverse occurrences, 81 (32.4%) were determined to be of major severity and 169 (67.6%) of minor severity. Quality improvement activities, mostly changes to hospital policies and work processes, were implemented with the aim of preventing the recurrence of specific adverse patient events. Over two years the number of adverse events fell from 84 (3.26% of all patient attendances) in the pre-intervention quarter to 12 (0.48% of all patient attendances) in the final quarter (relative risk reduction 85.3% (95% Cl, 62.7% to 100%)). Conclusions: Adverse events in emergency departments can be efficiently detected and their rate reduced using retrospective medical record screening together with clinical review, analysis and action to prevent recurrences.