Assessing and improving methods for the voluntary reporting of errors in healthcare, preventing harm in surgery and the measurement of avoidable death

Abstract

Since the government paper “An organization with a memory” the National Health Service has sought to prevent healthcare-related harm. It is unclear, a decade later, whether patients are now “safer”. One of the principal problems in this developing field is the imprecision with which harm is measured. All methods contain epidemiological flaws that reduce their utility. The current methods such as retrospective case note review or voluntary safety reporting systems are cumbersome or prone to non-responder bias.

This thesis reviewed the success of innovations to reduce surgical adverse events. It assessed methods of measurement of patient safety in healthcare with a focus on voluntary reporting and retrospective case note review. It evaluated the utility of the National Reporting and Learning System (NRLS) to increase the understanding and learning from the available data. A mixed method approach was used with both qualitative and quantitative techniques. Methods for measuring avoidable death at a hospital level involving explicit retrospective case note review were developed

In a systematic review current methods for preventing surgical harm were found to be limited in their efficacy to statistically reduce morbidity and mortality. The NRLS data were found to be unable to correlate with existing measures of hospital quality. A system of improved classification of surgical adverse events was developed. International expert review delineated the future role of reporting systems. A novel tool for performing case note reviews in a reproducible fashion was validated and shown to elucidate efficiently the avoidability of hospital deaths.

By tailoring and improving reporting systems and retrospective case note review methods, this thesis has been able to demonstrate improved measurement of harm and avoidable death. This will provide a better understanding of the scale and nature of healthcare-related harm.