Preventable patient harm across healthcare services
This is the largest and most comprehensive systematic review which has examined the prevalence, severity and key types of preventable patient harm.
What were the key findings?
The majority of studies typically classify patient harm as preventable if it occurs as a result of an identifiable modifiable cause and its future recurrence can be avoided by reasonable adaptation to a process or adherence to guidelines.
At least 6% of patients experienced preventable harm across the healthcare service.
13% of the identified preventable harm causes prolonged or permanent disability or leads to death.
The main types of patient safety incidents which contribute to preventable harm are medication incidents, diagnostic incidents and incidents occurring following the receipt of suboptimal clinical management/therapies.
Despite the large number of studies included in this review, the quality and depth of data presented on preventable patient harm is very low. Preventability was reported as a secondary outcome across the vast majority of the studies – ie broadly, most of the studies were not focused on preventability.
Research to identify the major preventable sources of severe patient harm as well as the stages, the systems and the practitioners involved in the occurrence of preventable harmful incidents is needed.
Why did we commission this research?
To know more about the nature of the preventable harms patients can experience. Our interest lies in targeting frequently occurring harms for further research and analysis. This will help us understand the nature and circumstances in which these occur. And, it may identify opportunities for reducing the likelihood of their future occurrence.
What did the research involve?
The research involved a systematic review of 149 distinct studies with meta-analysis.
Read the full report