Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis

I would argue that the neuronal cascade of death is preventable. Thus 10 million yearly stroke survivors  are harmed by this. The status quo has nothing to prevent that harm but LEADERS change the status quo. WHOM THE HELL ARE OUR STROKE LEADERS?

Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4185 (Published 17 July 2019) Cite this as: BMJ 2019;366:l4185

Linked editorial

Preventable harm: getting the measure right

• Article
• Related content
• Metrics
• Responses
• Peer review

1. Maria Panagioti, senior lecturer1,  
2. Kanza Khan, PhD candidate1,  
3. Richard N Keers, lecturer2,  
4. Aseel Abuzour, postdoctoral research associate2,  
5. Denham Phipps, lecturer2,  
6. Evangelos Kontopantelis, professor1,  
7. Peter Bower, professor1,  
8. Stephen Campbell, chair1,  
9. Razaan Haneef, foundation year 2 doctor3,  
10. Anthony J Avery, dean4,  
11. Darren M Ashcroft, professor1

Author affiliations

1. Correspondence to: M Panagioti maria.panagioti@manchester.ac.uk

• Accepted 30 May 2019

Abstract

Objective To systematically quantify the prevalence, severity, and nature of preventable patient harm across a range of medical settings globally.

Design Systematic review and meta-analysis.

Data sources Medline, PubMed, PsycINFO, Cinahl and Embase, WHOLIS, Google Scholar, and SIGLE from January 2000 to January 2019. The reference lists of eligible studies and other relevant systematic reviews were also searched.

Review methods Observational studies reporting preventable patient harm in medical care. The core outcomes were the prevalence, severity, and types of preventable patient harm reported as percentages and their 95% confidence intervals. Data extraction and critical appraisal were undertaken by two reviewers working independently. Random effects meta-analysis was employed followed by univariable and multivariable meta regression. Heterogeneity was quantified by using the I² statistic, and publication bias was evaluated.

Results Of the 7313 records identified, 70 studies involving 337 025 patients were included in the meta-analysis. The pooled prevalence for preventable patient harm was 6% (95% confidence interval 5% to 7%). A pooled proportion of 12% (9% to 15%) of preventable patient harm was severe or led to death. Incidents related to drugs (25%, 95% confidence interval 16% to 34%) and other treatments (24%, 21% to 30%) accounted for the largest proportion of preventable patient harm. Compared with general hospitals (where most evidence originated), preventable patient harm was more prevalent in advanced specialties (intensive care or surgery; regression coefficient b=0.07, 95% confidence interval 0.04 to 0.10).

Conclusions Around one in 20 patients are exposed to preventable harm in medical care. Although a focus on preventable patient harm has been encouraged by the international patient safety policy agenda, there are limited quality improvement practices specifically targeting incidents of preventable patient harm rather than overall patient harm (preventable and non-preventable). Developing and implementing evidence-based mitigation strategies specifically targeting preventable patient harm could lead to major service quality improvements in medical care which could also be more cost effective.