Continuous monitoring of adverse events: influence on the quality of care and the incidence of errors in general surgery

World J Surg. 2009 Feb;33(2):191-8. doi: 10.1007/s00268-008-9848-6.


Background: This study was designed to determine the incidence of adverse events and errors in the care of surgical patients and to demonstrate that continuous prospective collection of data on adverse events can improve quality of care and reduce the number of errors. Retrospective studies find adverse events in approximately 5% of patients admitted. Prospective studies publish figures of approximately 30%. No studies to date have tried to use continuous collection of data on adverse events to reduce the incidence of errors.

Methods: Longitudinal prospective surveillance of adverse events in patients admitted to the Surgery Service during a 22-month period. Sequelae after discharge and errors during hospital stay were evaluated by peer review.

Results: A total of 3,807 patients were controlled: 1,177 patients presented 2,193 adverse events (30.9% of admissions); 330 adverse events due to errors were detected in 258 patients (6.9% of admissions). Thirty-four deaths were considered due to adverse events (0.89% of admissions), and in 11 cases mortality was deemed avoidable (0.29% of admissions). The incidence of adverse events remained constant during the study period, but errors decreased from 11.1% to 4.5% (P = 0.005).

Conclusions: This is the first attempt to determine the prevalence of errors in surgery. Introducing systematic programs for recording adverse events can reduce error rates and promote a culture of patient safety in a General Surgery Department.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Confidence Intervals
  • Female
  • General Surgery / standards*
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Longitudinal Studies
  • Male
  • Medical Errors / prevention & control*
  • Medical Errors / statistics & numerical data*
  • Middle Aged
  • Outcome and Process Assessment, Health Care*
  • Prospective Studies
  • Quality of Health Care*
  • Risk Factors
  • Spain / epidemiology