Estimating the frequency of inpatient adverse events using a two-step retrospective chart review: a study protocol

Syed Sabih Ul Hassan, Fozia Asif, Ghazal Haque, Farwa Ayub, Tahir Munir, Fauzia Khan, Sameen Siddiqi, Asad Latif

Research output: Contribution to journalArticlepeer-review


Introduction Adverse events are a major cause of patient harm in the hospitalised setting. Low-income and middle-income countries account for a disproportionate share of the global burden of adverse events. However, patient safety research is still centred around high-income countries and high-resource health systems. The methods and data produced from these efforts are ill-suited to low-income and middle-income systems due to the social and technical differences between these settings. We aim to use our pilot-tested, locally developed methodology to estimate the frequency and characteristics of adverse events in hospitalised patients in a lower-middle-income country to inform patient safety policies and initiatives. Methods and analysis This multi-centre study will employ a two-step chart review methodology to identify adverse events in a representative sample of patients admitted at five hospitals between 1 January 2019 and 31 December 2019. The first step will include assessing patient files against a list of triggers to detect adverse events and the second step will involve an in-depth review of the events to capture pertinent characteristics. The triggers have been adapted from validated tools used in other studies. The reviewing team will be trained on the use of research tools and operational definitions to ensure that data are collected uniformly. The main outcome of interest is the rate at which adverse events occur in hospitalised patients. Further analysis will look to identify and quantify associations between the main outcome of interest and a variety of variables such as patient age and gender using tests of independence and regression techniques. Ethics and dissemination This study protocol has been approved by the Ethics Review Committee at Aga Khan University (Reference number: 2023-6324-24566). The findings of this study will be published in a peer-reviewed journal and disseminated to the public through national and international conferences, workshops, websites and social media.

Original languageEnglish
Article numbere076971
JournalBMJ Open
Issue number12
Publication statusPublished - 6 Dec 2023


  • Health & safety
  • Quality in health care
  • Retrospective Studies


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