Objectives: Patient safety is important in all healthcare settings. Studies have found that adverse events affect approximately 10% of patients admitted to acute care hospital, but few studies have examined the state of patient safety specifically in rehabilitation. This study determined the incidence, most common types and severities of adverse events among inpatients undergoing ABI (Acquired Brain Injury) rehabilitation.
Design: The charts of 108 consecutive inpatients who were admitted for rehabilitation in 2017 to two units in an academic, tertiary rehabilitation hospital that provided care for patients with traumatic and non-traumatic brain injuries were reviewed by four board-certified physiatrists. Adverse events were identified and classified for severity and type using the WHO International Classification for Patient Safety. Preventability was rated on a 6-point Likert scale. The physiatrists used a standardized rating manual and underwent a training phase using ten charts during which inter-rater reliability was evaluated. Incident reports of adverse events from the hospital’s voluntary reporting system were also reviewed.
Results: Adverse events affected 52.78% of patients. During the study period, the incidence of adverse events was 18.34 per 1000 patient days. Most adverse events identified were mild in severity (98.51%) and the rest were of moderate severity. The two most common types of adverse events were 1) patient incidents (56.72%) such as falls, pressure ulcers and skin tears, and 2) patient behaviours such as missing patient, assault or sexual behaviour (16.42%). Of the 80 adverse events identified in the study, 44.78% were preventable. Fleiss Kappa for inter-rater reliability was 0.60.
Conclusions: Adverse events appear more frequently in ABI rehabilitation than in the general inpatient setting, possibly due to this patient population’s complex behavioural, cognitive and physical challenges. Future efforts to improve patient safety in ABI rehabilitation should focus on reducing falls, skin injuries and behavioural incidents.
Rouaa Mandurah– Physiatry Fellow - ABI Rehab, University Health Network - Toronto Rehabilitation Institute
Alice Kam– Physiatrist, University Health Network - Toronto Rehabilitation Institute
Alan Tam– Physician, Toronto Rehabilitation Institute
Mark Bayley– Physiatrist-in-Chief & Program Medical Director, UHN - Toronto Rehabilitation Institute
Meiqi Guo– Physiatrist and Physician Lead for ABI Rehab, Toronto Rehabilitation Institute, University Health Networks