Detecting and reducing hospital adverse events: outcomes of the Wimmera clinical risk management program

Med J Aust. 2001 Jun 18;174(12):621-5. doi: 10.5694/j.1326-5377.2001.tb143469.x.


Objectives: To determine if an integrated clinical risk management program that detects adverse patient events in a hospital, analyses their risk and takes action can alter the rate of adverse events.

Design: Longitudinal survey of adverse patient events over eight years of progressive implementation of the risk management program.

Participants and setting: 49,834 inpatients (July 1991 to September 1999) and 20,050 emergency department patients (October 1997 to September 1999) at a rural base hospital in the Wimmera region of Victoria.

Main outcome measures: Rates of adverse events detected by medical record review and clinical incident and general practitioner reporting.

Results: The annual rate of inpatient adverse events decreased between the first and eighth years of the study from 1.35% of all patient discharges (69 events) to 0.74% (49 events) (P<0.001). Absolute risk reduction was 0.61% (95% CI, 0.23%-0.99%), and relative risk reduction was 44.9% (95% CI, 16.9%-72.9%). The quarterly rate of emergency department adverse events decreased between the first and eighth quarters of monitoring from 3.26% of all attendances (84 events) to 0.48% (12 events) (P< 0.001). Absolute risk reduction was 2.78% (95% CI, 2.04%-3.52%), and relative risk reduction was 85.3% (95% CI, 62.7%-100%).

Conclusions: Adverse patient events can be detected, and their frequency reduced, using multiple detection methods and clinical improvement strategies as part of an integrated clinical risk management program.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Clinical Competence / standards*
  • Emergency Service, Hospital / standards
  • Family Practice / standards
  • Health Services Research
  • Hospitals, Rural / organization & administration
  • Hospitals, Rural / standards*
  • Humans
  • Iatrogenic Disease / prevention & control*
  • Longitudinal Studies
  • Medical Errors / prevention & control*
  • Medical Errors / statistics & numerical data
  • Medical Errors / trends
  • Models, Organizational
  • Outcome Assessment, Health Care
  • Patient Satisfaction
  • Program Evaluation
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Risk Management / organization & administration*
  • Systems Analysis
  • Victoria / epidemiology