Management of reported patient related serious adverse events (PRSAE) in a central hospital in the Gauteng Province

Abstract

Patient Related Serious Adverse Events (PRSAEs) are likely to occur in a tertiary institution where highly specialised types of treatments are being provided and warrant high levels of expertise. The patients’ disease profiles are complicated and often for better outcomes require urgent interventions. It is mandatory that health professionals report all PRSAEs as soon as they occur but often an incident of a PRSAE got to be detected by management either through media query, complaint, a medico-legal claim or even as enquiry from Health Professional Bodies [such as Health Professional Council of South Africa (HPCSA), South African Nursing Council (SANC), South African Pharmacy Council (SAPC)]. By properly managing reported PRSAEs, it may be possible to develop and to put strategies that can minimise PRSAEs. This can also ensure that employees report PRSAEs occurrence, as part of their daily work. However, this would require an understanding of the factors that might be associated with PRSAEs in an institution. Aim: To describe the factors associated with patient-related adverse events in the central hospital in the Gauteng Province [Steve Biko Academic Hospital (SBAH)] during a two-year study period (01 January 2016 to 31 December 2017) and management of these events by the management of that Hospital. Methodology: The setting of this study was SBAH. A retrospective study design was used. Routinely collected data from the PRSAEs register (Quality Assurance division) was used as primary source of data. In addition, other sources of information (such as Complaint register, Media queries and published articles, Medico-legal claim records of SBAH, Mortality & Morbidity Meeting minutes and known enquiries related to cases against the professionals when they were performing duties in SBAH were used as secondary sources for the study. Approval from Gauteng Department of Health Research Monitoring Directorate and Chief Executive Officer of Steve Biko Academic Hospital, Post-Graduate Research Committee of the Faculty of Health Science of the University of Witwatersrand as well as Research Ethics Committees of the Universities of Witwatersrand and Pretoria were sought before commencement of the study. After all necessary approvals were obtained, the research data were collected, analysed and reported on. Results: Records of 390 participants were used for analysis. It was noted that there was 25% reduction in PRSAEs from 2016 (224) to 2017 (166). The majority of the events were classified as medium (55%) and high (41%) risk categories and few in the low (3%) and extreme categories. Although the numbers were almost equal in medium and high-risk categories in 2016, there was a significant reduction in the number in high risk categories in 2017. The majority of the subjects were in the middle age group (21-70 years) with no significant difference between male and female subjects. The majority of the PRSAEs happened in Medicine, followed by Operating theatres, Surgery, and Psychiatry. The main clinical conditions of these subjects included Oncology, Psychiatry, Surgical gastroenterology and trauma. Health professional factors were identified as the most important contributory factors. Abscondment of patients was found to be one of the major Patient factors. Malfunctioning of lifts was the major factor in the Administration category. The investigation period of the majority of the PRSAEs were completed within a reasonable time (median 8 days), with a significant reduction from 2016 to 2017. Although the majority of the four intervals [namely intervals between (a) Dates of Incidence and Reporting, (b) Dates of Reporting and Submission of written report (c) Dates of Submission of written report and SAE Committee meetings, and (d) Dates of SAE Committee meetings and Closure] were short, in few cases the interval became long, which would require further investigation.

Conclusion: It is envisaged that this study would contribute valuable information regarding the causes and effects of PRSAEs in the SBAH. In addition, the findings of this study could stimulate future research to determine reasons for health professional factors and targeted in-service training to prevent them in future.