Identification of adverse events at an orthopedics department in Sweden

Acta Orthop. 2008 Jun;79(3):396-403. doi: 10.1080/17453670710015319.


Background and purpose: Adverse events (AEs) are common in acute care hospitals, but there have been few data concerning AEs in orthopedic patients. We tested and evaluated a patient safety model (the Wimmera clinical risk management model) and performed a three-stage retrospective review of records to determine the occurrence of AEs in adult orthopedic inpatients.

Methods: The computerized medical and nursing records of 395 patients were included and screened for AEs using 12 criteria. Positive records were then reviewed by two senior orthopedic surgeons using a standardized protocol. An AE had to have occurred during the index admission or within the first 28 days of discharge from the Orthopedics Department. Screening of additional systems for reporting of AEs was also carried out for the same period. The number of patients suffering an AE and the number of AEs were recorded.

Results: Altogether, 60 (15 %) of 395 patients checked in the screening of records experienced 65 AEs (16%) due to healthcare management. Of the 65 AEs, 34 were estimated to have a high degree of preventability. 47 of the 65 AEs occurred during the index admission and 18 within 28 days of discharge. In screening of local and nationwide reporting systems for the same patients, 4 additional AEs were identified-2 of which were previously unknown. 67 different AEs were detected by using the Wimmera model (17%)

Interpretation: Using the Wimmera model with manual screening and review of records, many more AEs were detected than in all other traditional local and nationwide reporting systems used in Sweden when screening was done for the same period.

MeSH terms

  • Adult
  • Clinical Competence / standards
  • Data Collection
  • Hospital Departments / standards*
  • Humans
  • Medical Errors / prevention & control
  • Medical Errors / statistics & numerical data
  • Orthopedics / standards*
  • Outcome Assessment, Health Care / methods
  • Quality Assurance, Health Care
  • Retrospective Studies
  • Risk Management*
  • Safety Management
  • Sweden / epidemiology