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The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada.

https://arctichealth.org/en/permalink/ahliterature179979
Source
CMAJ. 2004 May 25;170(11):1678-86
Publication Type
Article
Date
May-25-2004
Author
G Ross Baker
Peter G Norton
Virginia Flintoft
Régis Blais
Adalsteinn Brown
Jafna Cox
Ed Etchells
William A Ghali
Philip Hébert
Sumit R Majumdar
Maeve O'Beirne
Luz Palacios-Derflingher
Robert J Reid
Sam Sheps
Robyn Tamblyn
Author Affiliation
Department of Health Policy, Management and Evaluation, University of Toronto, McMurrich Building Room 2031, 12 Queen's Park Crescent West, Toronto, Ontario M5S 1A8, Canada. ross.baker@utoronto.ca
Source
CMAJ. 2004 May 25;170(11):1678-86
Date
May-25-2004
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Health Facility Size
Hospital Mortality
Hospitals, Community - standards - statistics & numerical data - utilization
Hospitals, Teaching - standards - statistics & numerical data - utilization
Humans
Iatrogenic Disease - epidemiology - prevention & control
Incidence
Length of Stay - statistics & numerical data
Medical Audit - methods
Medical Errors - prevention & control - statistics & numerical data
Patient Admission - statistics & numerical data
Patient Advocacy
Safety Management - standards
Abstract
Research into adverse events (AEs) has highlighted the need to improve patient safety. AEs are unintended injuries or complications resulting in death, disability or prolonged hospital stay that arise from health care management. We estimated the incidence of AEs among patients in Canadian acute care hospitals.
We randomly selected 1 teaching, 1 large community and 2 small community hospitals in each of 5 provinces (British Columbia, Alberta, Ontario, Quebec and Nova Scotia) and reviewed a random sample of charts for nonpsychiatric, nonobstetric adult patients in each hospital for the fiscal year 2000. Trained reviewers screened all eligible charts, and physicians reviewed the positively screened charts to identify AEs and determine their preventability.
At least 1 screening criterion was identified in 1527 (40.8%) of 3745 charts. The physician reviewers identified AEs in 255 of the charts. After adjustment for the sampling strategy, the AE rate was 7.5 per 100 hospital admissions (95% confidence interval [CI] 5.7- 9.3). Among the patients with AEs, events judged to be preventable occurred in 36.9% (95% CI 32.0%-41.8%) and death in 20.8% (95% CI 7.8%-33.8%). Physician reviewers estimated that 1521 additional hospital days were associated with AEs. Although men and women experienced equal rates of AEs, patients who had AEs were significantly older than those who did not (mean age [and standard deviation] 64.9 [16.7] v. 62.0 [18.4] years; p = 0.016).
The overall incidence rate of AEs of 7.5% in our study suggests that, of the almost 2.5 million annual hospital admissions in Canada similar to the type studied, about 185 000 are associated with an AE and close to 70 000 of these are potentially preventable.
Notes
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Cites: N Z Med J. 2002 Dec 13;115(1167):U27112552260
Cites: N Z Med J. 2003 Oct 10;116(1183):U62414581938
Cites: CMAJ. 2004 Feb 3;170(3):345-914757670
Cites: Biometrics. 1977 Mar;33(1):159-74843571
Comment In: CMAJ. 2004 Oct 12;171(8):833; author reply 83415477611
Comment In: CMAJ. 2004 Oct 12;171(8):833-4; author reply 83415477610
Comment In: CMAJ. 2004 Oct 12;171(8):832; author reply 83415477609
Comment In: CMAJ. 2004 Oct 12;171(8):829, 832; author reply 83415477606
Comment In: CMAJ. 2004 May 25;170(11):1688-915159368
Comment In: CMAJ. 2004 Oct 12;171(8):834; author reply 83415477613
Comment In: CMAJ. 2010 Aug 10;182(11):121420696812
PubMed ID
15159366 View in PubMed
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Factors predicting adherence to the Canadian Clinical Practice Guidelines for nutrition support in mechanically ventilated, critically ill adult patients.

https://arctichealth.org/en/permalink/ahliterature155514
Source
J Crit Care. 2008 Sep;23(3):301-7
Publication Type
Article
Date
Sep-2008
Author
Naomi E Jones
Rupinder Dhaliwal
Andrew G Day
Hélène Ouellette-Kuntz
Daren K Heyland
Author Affiliation
Department of Community Health and Epidemiology, Queen's University, Kingston, ON, Canada.
Source
J Crit Care. 2008 Sep;23(3):301-7
Date
Sep-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Canada
Critical Illness - therapy
Female
Guideline Adherence - statistics & numerical data
Hospital Bed Capacity - standards - statistics & numerical data
Hospitals, Community - standards - statistics & numerical data
Hospitals, University - standards - statistics & numerical data
Humans
Intensive Care Units - standards - statistics & numerical data
Male
Middle Aged
Nutritional Support - standards
Practice Guidelines as Topic
Prospective Studies
Respiration, Artificial
Sex Factors
Young Adult
Abstract
The aim of this study was to determine factors that are associated with adherence to the Canadian nutrition support clinical practice guidelines (CPGs).
We conducted a secondary analysis of data from a prospective observational cohort study of nutrition support practices in 58 intensive care units (ICUs) across Canada, grouped into 50 clusters. Adequacy of enteral nutrition (EN) (energy received from EN / energy prescribed by the dietitian x 100), was used as a marker of adherence to the guidelines. We applied hierarchical modeling techniques to examine the impact of various hospital, ICU, and patient factors on EN adequacy.
The overall average EN adequacy was 51.3% (SE, 1.8%). In a multiple regression analysis, after adjusting for varying days of observation, hospital type (academic 54.3% vs community 45.2%, P
PubMed ID
18725033 View in PubMed
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Potential gaps in congestive heart failure management in a rural hospital.

https://arctichealth.org/en/permalink/ahliterature173480
Source
Can J Rural Med. 2005;10(3):155-61
Publication Type
Article
Date
2005
Author
Margaret D Sanborn
Douglas G Manuel
Ewa Ciechanska
Douglas S Lee
Author Affiliation
South Bruce Grey Health Care Centre, Chesley, Ont. msanborn@sbghc.on.ca
Source
Can J Rural Med. 2005;10(3):155-61
Date
2005
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Female
Health Care Surveys
Health Services Accessibility - standards - statistics & numerical data
Heart Failure - drug therapy - epidemiology - therapy
Hospitals, Community - standards - statistics & numerical data
Hospitals, Rural - standards - statistics & numerical data
Humans
Middle Aged
Ontario - epidemiology
Patient Care Planning - standards - statistics & numerical data
Retrospective Studies
Rural Health
Rural Health Services - standards - statistics & numerical data
Rural Population - statistics & numerical data
Abstract
Congestive heart failure (CHF) is increasingly recognized as an important cause of morbidity and mortality. Previous studies in urban settings have shown that patients frequently are not receiving recommended therapy. There is a paucity of studies that have evaluated CHF management in a rural setting. We therefore reviewed hospital and outpatient care in this setting as an initial step toward improving CHF care.
A retrospective chart review was used to examine the care of all 34 patients hospitalized for CHF from 2000-2001 in a small rural hospital, to assess the need for improved CHF management.
The median age of the patients was 78 yr, and a number of them had many co-morbid cardiovascular risks. Similar to other studies, only 23% of patients were prescribed recommended doses of angiotensin-converting enzyme (ACE) inhibitors. Use of beta-blockers was far below expected rates. Although there was follow-up care for nearly all patients (97%), few patients had echocardiography performed (38%) or had their medications altered in the outpatient setting.
There is a need for improved management of CHF in the rural setting. Approaches to improving CHF care should use the continuity of care advantage provided by primary care physicians to optimize outpatient medical treatment regimens and improve access to diagnostic services such as echocardiography.
PubMed ID
16079031 View in PubMed
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Surgical site infection rates at the Pontiac Health Care Centre, a rural community hospital.

https://arctichealth.org/en/permalink/ahliterature170889
Source
Can J Rural Med. 2006;11(1):41-8
Publication Type
Article
Date
2006
Author
Runi Chattopadhyay
Sevag Zaroukian
Earle Potvin
Author Affiliation
Department of Surgery, Pontiac Health Care Centre, Shawville, Quebec, Canada. runi.chatto.padhyay@ucsfmedctr.org
Source
Can J Rural Med. 2006;11(1):41-8
Date
2006
Language
English
Publication Type
Article
Keywords
Cross Infection - epidemiology - microbiology
Female
Follow-Up Studies
Health Care Surveys
Hospitals, Community - standards - statistics & numerical data
Hospitals, Rural - standards - statistics & numerical data
Humans
Infection Control - standards - trends
Male
Multicenter Studies as Topic
Prevalence
Quebec - epidemiology
Reference Values
Retrospective Studies
Risk assessment
Severity of Illness Index
Surgical Wound Infection - diagnosis - epidemiology
Abstract
The prevalence of surgical site infections (SSIs) at the Pontiac Health Care Centre, a rural hospital, was compared with rates obtained by large multicentre studies. Postoperative nosocomial infection (NI) rates were also calculated.
A review of all surgical interventions involving an incision, excluding ophthalmological procedures, performed between October 2001 and March 2003 (n = 831) was undertaken. Various clinical parameters were recorded. Infection rates were calculated. Data were analyzed using either the chi2 or Student's t test.
The overall SSI rate was 5.54%: 3.50% in clean cases (C), 6.77% in clean-contaminated cases (CC), and 14.58% in contaminated or dirty cases (D). The postoperative NI rate was 6.62% (C, 3.68%; CC, 9.90%; D, 16.67%). The mean duration of surgery was significantly higher among patients with SSIs and with NIs than those without infections for CC (133 +/- 95 v. 78 +/- 60 min, p
PubMed ID
16454971 View in PubMed
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A survey of medical quality assurance programs in Ontario hospitals.

https://arctichealth.org/en/permalink/ahliterature224497
Source
CMAJ. 1992 Jan 15;146(2):153-60
Publication Type
Article
Date
Jan-15-1992
Author
B. Barrable
Author Affiliation
Ontario Hospital Association, Don Mills.
Source
CMAJ. 1992 Jan 15;146(2):153-60
Date
Jan-15-1992
Language
English
Publication Type
Article
Keywords
Follow-Up Studies
Hospital Administration - standards - statistics & numerical data
Hospital Bed Capacity
Hospital Mortality
Hospitals, Community - standards - statistics & numerical data
Hospitals, Teaching - standards - statistics & numerical data
Humans
Medical Staff, Hospital
Ontario - epidemiology
Prevalence
Quality Assurance, Health Care - statistics & numerical data
Questionnaires
Abstract
To determine the prevalence and types of medical quality assurance practices in Ontario hospitals.
Survey.
All teaching, community, chronic care, rehabilitation and psychiatric hospitals that were members of the Ontario Hospital Association as of May 1990.
The person deemed by the chief executive officer of each hospital to be most responsible for medical administration.
A questionnaire to obtain information on each hospital's use of criteria audit, indicators inventory, occurrence screening and reporting, and utilization review and management (URM) activities.
Prevalence of the use of the quality assurance activities, the people responsible for the activities and the relative success of the URM program in modifying physicians' performance.
Of the 245 member hospitals participants from 179 (73%) responded. Criteria audits were performed in 136 (76%), indicators inventory in 43 (24%), occurrence screening in 44 (25%), occurrence reporting in 61 (34%) and URM in 123 (69%). In-hospital deaths were reviewed in 157 (88%) of the hospitals. In all, 87 (55%) of the respondents from hospitals that had a URM program or were developing one indicated that their program was successful in modifying physicians' practices, and 29 (18%) reported that it was not successful; 26 (16%) stated that the effect was still unknown, and 16 (10%) did not respond. Seventy (40%) stated that results of tissue reviews were reported at least 10 times per year and 94 (83%) that medical record reviews were reported at least as often. The differences in the prevalence of the quality assurance activities between the hospitals were not found to be significant.
Many Ontario hospitals are conducting a wide variety of quality assurance activities. Further study is required to determine whether the differences in prevalence of these activities between hospitals would be significant in a larger, perhaps national, sample. Strategies are needed to ensure universal involvement and participation in the improvement of the quality of care and the assessment of the cost-effectiveness of health care treatments. Recommendations to achieve these objectives are suggested.
Notes
Cites: CMAJ. 1990 Nov 15;143(10):1025-302224668
Cites: Qual Assur Health Care. 1990;2(1):13-92103868
Cites: N Engl J Med. 1989 Jan 5;320(1):53-62909878
Comment In: CMAJ. 1992 Aug 1;147(3):287, 2901643591
Comment In: CMAJ. 1992 Aug 1;147(3):2871643590
PubMed ID
1735040 View in PubMed
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