JMIR Publications

ABSTRACT

Background:

Lower- and middle-income countries bear a disproportionate share of the global burden of adverse events in healthcare. Despite this, patient safety research is predominantly conducted in high-income countries with well-developed healthcare systems, resulting in evidence and methodologies that have limited applicability in resource-constrained settings.  

Objective:

This pilot study primarily aimed to identify the most suitable methodology for a full-scale study to detect inpatient adverse events at a tertiary care hospital in a lower middle-income country. Secondly, we aimed to use our experience with this study to further adapt the selected methodology to our setting.

Methods:

This external pilot study utilised a two-step retrospective chart review methodology. Two separate screening tools were compared to identify which tool performed better in our setting. We reviewed the medical records of patients that were discharged between 1st of January and 31st of December 2019 from a tertiary care hospital in a lower-middle-income country in South Asia. The main outcome of interest was the rate of adverse events in hospitalised patients reported as the total number of adverse events experienced per 100 admissions.

Results:

A total of 100 medical records were screened with Tool 1A, with the mean (SD) patient age being 39.2 (27.7) years and the mean (SD) length of stay being 3.3 (2.8) days. Only 1 adverse event was identified with Tool 1A, resulting in an adverse event rate of 1 event per 100 hospital admissions. Tool IB was also used to screen a total of 100 medical records. The mean (SD) patient age was found to be 39.8 (28.4) years, with the mean (SD) length of stay equal to 3.5 (3.4) days. A total of 30 adverse events were identified across 22 patient files, resulting in an adverse event rate of 30 events per 100 hospital admissions.

Conclusions:

This study demonstrates that Tool IB, adapted from the Global Trigger Tool, represents an appropriate methodology to identify adverse events in hospitalised patients in a lower-middle-income country. Furthermore, the findings and experiences from this study have been used to improve the design and procedures of our research methodology prior to implementation in a full-scale study.