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2 results

  • Adverse events among patients registered in high-acuity areas of the emergency department: a prospective cohort study

  • Lisa Anne Calder, Alan Forster, Melanie Nelson, Jason Leclair, Jeffrey Perry, Christian Vaillancourt, Guy Hebert, A. Adam Cwinn, George Wells, Ian Stiell
  • Journal:
    Canadian Journal of Emergency Medicine / Volume 12 / Issue 5 / September 2010
    Published online by Cambridge University Press:
    21 May 2015, pp. 421-430
    Print publication:
    September 2010
    • Article
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  • Objective:

    To enhance patient safety, it is important to understand the frequency and causes of adverse events (defined as unintended injuries related to health care management). We performed this study to describe the types and risk of adverse events in high-acuity areas of the emergency department (ED).

    Methods:

    This prospective cohort study examined the outcomes of consecutive patients who received treatment at 2 tertiary care EDs. For discharged patients, we conducted a structured telephone interview 14 days after their initial visit; for admitted patients, we reviewed the inpatient charts. Three emergency physicians independently adjudicated flagged outcomes (e.g., death, return visits to the ED) to determine whether an adverse event had occurred.

    Results:

    We enrolled 503 patients; one-half (n = 254) were female and the median age was 57 (range 18–98) years. The majority of patients (n = 369, 73.3%) were discharged home. The most common presenting complaints were chest pain, generalized weakness and abdominal pain. Of the 107 patients with flagged outcomes, 43 (8.5%, 95% confidence interval 8.1%–8.9%) were considered to have had an adverse event through our peer review process, and over half of these (24, 55.8%) were considered preventable. The most common types of adverse events were as follows: management issues (n = 18, 41.9%), procedural complications (n = 13, 30.2%) and diagnostic issues (n = 10, 23.3%). The clinical consequences of these adverse events ranged from minor (urinary tract infection) to serious (delayed diagnosis of aortic dissection).

    Conclusion:

    We detected a higher proportion of preventable adverse events compared with previous inpatient studies and suggest confirmation of these results is warranted among a wider selection of EDs.

  • A COMPARISON OF CLINICAL PRACTICE GUIDELINE APPRAISAL INSTRUMENTS

  • Ian D. Graham, Lisa A. Calder, Paul C. Hébert, Anne O. Carter, Jacqueline M. Tetroe
  • Journal:
    International Journal of Technology Assessment in Health Care / Volume 16 / Issue 04 / October 2000
    Published online by Cambridge University Press:
    25 May 2001, pp. 1024-1038

  • Objective: To identify and compare clinical practiceguideline appraisal instruments.

    Methods: Appraisal instruments,defined as instruments intended to be used for guideline evaluation,were identified by searching MEDLINE (1966–99) using the MedicalSubject Heading (MeSH) practice guidelines, reviewing bibliographiesof the retrieved articles, and contacting authors of guidelineappraisal instruments. Two reviewers independently examined thequestions/statements from all the instruments and thematicallygrouped them. The 44 groupings were collapsed into 10 guidelineattributes. Using the items, two reviewers independently undertook acontent analysis of the instruments.

    Results: Fifteen instruments were identified, and two were excludedbecause they were not focused on evaluation. All instruments weredeveloped after 1992 and contained 8 to 142questions/statements. Of the 44 items used for the content analysis,the number of items covered by each instrument ranged from 6 to 34.Only the instrument by Cluzeau and colleaguesincluded at least one item for each of the 10 attributes, andit addressed 28 of the 44 items. This instrument and that of Shaneyfelt et al. are the only instruments that have so far been validated.

    Conclusions: A comprehensive, concise, and valid instrument could helpusers systematically judge the quality and utility of clinicalpractice guidelines. The current instruments vary widely inlength and comprehensiveness. There is insufficient evidenceto support the exclusive use of any one instrument, although theCluzeau instrument has received the greatest evaluation. Moreresearch is required on the reliability and validity of existingguideline appraisal instruments before any one instrument can becomewidely adopted.