Adverse events in a Tunisian hospital: Results of a retrospective cohort study

Background: Despite the worldwide growing attention to patient safety, Tunisia has no data on the magnitude and consequences of hospital adverse events (AEs). Objective: To estimate the incidence, nature and consequences of AEs and preventable AEs in a university hospital in Tunisia. Design and setting: We opted for a two-stage retrospective medical record review of 620 inpatients admitted during 2005 based on the use of 18 screening criteria. Records were reviewed by a trained medical student, then by an expert physician when one or more criteria were identified. Main outcomes measures: We determine the incidence, preventability and consequences of the AEs. Patients and admissions characteristics were also recorded. Results: Among 620 inpatients, 62 inpatients experienced an AE with an incidence of 10% (95% CI [7.6-12.3]). Surgical/invasive procedures and therapeutic errors were the most common AEs (55 and 21%, respectively). Among the confirmed events 60% were judged to be highly preventable and 21% led to patient death. All ages and both genders experienced equal rates of AEs. However, patients who experienced these events were significantly more exposed to extrinsic risk factors (all surgical interventions and invasive procedures that were listed in the revue form 2 of the questionnaire). Physician reviewers estimated that a total of 570 additional hospital days were associated with AEs. Conclusion: This study confirms that preventable AEs were not rare in our context. They caused human harm and consumed a significant part of hospital resources. Thus, targeted interventions are needed.