What is preventable harm in healthcare? A systematic review of definitions

Mohammed Nabhan, Tarig Elraiyah, Daniel R. Brown, James Dilling, Annie Leblanc, Victor M. Montori, Timothy Morgenthaler, James Naessens, Larry Prokop, Veronique Roger, Stephen Swensen, Rodney L. Thompson, M. Hassan Murad

Research output: Contribution to journalReview article

29 Scopus citations

Abstract

Background: Mitigating or reducing the risk of harm associated with the delivery of healthcare is a policy priority. While the risk of harm can be reduced in some instances (i.e. preventable), what constitutes preventable harm remains unclear. A standardized and clear definition of preventable harm is the first step towards safer and more efficient healthcare delivery system. We aimed to summarize the definitions of preventable harm and its conceptualization in healthcare. Methods. We conducted a comprehensive electronic search of relevant databases from January 2001 to June 2011 for publications that reported a definition of preventable harm. Only English language publications were included. Definitions were coded for common concepts and themes. We included any study type, both original studies and reviews. Two reviewers screened the references for eligibility and 28% (127/460) were finally included. Data collected from studies included study type, description of the study population and setting, and data corresponding to the outcome of interest. Three reviewers extracted the data. The level of agreement between the reviewers was calculated. Results: One hundred and twenty seven studies were eligible. The three most prevalent preventable harms in the included studies were: medication adverse events (33/127 studies, 26%), central line infections (7/127, 6%) and venous thromboembolism (5/127, 4%). Seven themes or definitions for preventable harm were encountered. The top three were: presence of an identifiable modifiable cause (58/132 definitions, 44%), reasonable adaptation to a process will prevent future recurrence (30/132, 23%), adherence to guidelines (22/132, 16%). Data on the validity or operational characteristic (e.g., accuracy, reproducibility) of definitions were limited. Conclusions: There is limited empirical evidence of the validity and reliability of the available definitions of preventable harm, such that no single one is supported by high quality evidence. The most common definition is presence of an identifiable, modifiable cause of harm.

Original languageEnglish (US)
Article number128
JournalBMC health services research
Volume12
Issue number1
DOIs
StatePublished - 2012

Keywords

  • Healthcare delivery
  • Preventable harm
  • Safety
  • Systematic review

ASJC Scopus subject areas

  • Health Policy

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