RESEARCH REPORTS

Incidence of adverse events related to health care in Spain: results of the Spanish National Study of Adverse Events

J M Aranaz-Andrés¹, C Aibar-Remón², J Vitaller-Murillo³, P Ruiz-López⁴, R Limón-Ramírez⁵, E Terol-García⁶ and the ENEAS work group

¹ Department of Preventive Medicine, Teaching Hospital of Sant Joan d’Alacant, Department of Public Health, History of Science and Gynaecology, Miguel Hernández University of Elche, Spain
² Department of Preventive Medicine, Teaching Hospital Lozano Blesa, Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Spain
³ Department of Public Health, History Science and Gynaecology, Miguel Hernández University of Elche, Spain
⁴ Quality Unit. 12 de octubre Hospital of Madrid, Spain
⁵ Department of Preventive Medicine, Teaching Hospital of Sant Joan d’Alacant, Department of Public Health, History Science and Gynaecology, Miguel Hernández University of Elche, Spain
⁶ Quality Office of the National Health Service, Ministry of Health and Consumer Affairs, Madrid, Spain

Correspondence to:
Dr J M A Andrés, Department of Public Health, History of Science and Gynaecology. Miguel Hernández University of Elche (San Juan Campus), Carretera de Alicante a Valencia s/n. 03550 San Juan de Alicante, Alicante, Spain; aranaz_jes{at}gva.es

Objective: To determine the incidence and incidence density of adverse events (AEs) in Spanish hospitals (including the pre-hospitalisation period).

Method: Retrospective cohort study.

Results: The incidence of patients with AEs relating directly to hospital care was 8.4% (95% CI 7.7% to 9.1%) and rose 9.3% (95% CI 8.6% to 10.1%), including those from the pre-hospitalisation period. The incidence density was 1.2 AEs per 100 patient-days (95% CI 1.1 to 1.3). The incidence of moderate and serious AEs was 5.6 AEs per 1000 patient-days (95% CI 4.9% to 6.3%). In 66.3% of AEs, additional procedures were required and in 69.9% additional treatments were required. In total 42.8% of AEs were considered as avoidable. Of the subjects with some intrinsic risk factors, 13.2% developed AEs compared with 5.2% of the subjects who had no risk factors (p<0.001), and 9.5% of the subjects who had some extrinsic risk factors developed AEs compared with 3.4% of the subjects who had not (p<0.001). Patients older than 65 years of age showed a higher frequency of AEs than those under this age (12.4% vs 5.4%, p<0.001, RR 2.5). The most frequent AEs were those associated with medication (37.4%), hospital infections of any type (25.3%) and those relating to technical problems during a procedure (25.0%). A total of 31.4% of the AEs involved an increase in the length of stay. The AEs associated with medical assistance caused 6.1 additional hospital stays by patient.

Conclusions: The incidence of patients with AE related to medical assistance in Spanish hospitals was relevant and similar to those found in the studies from Canada and New Zealand that had been conducted with comparable methodology. Patient vulnerability has been identified therein as playing a major role in generating healthcare-related AEs. These and other recent results indicate the need for AEs to be considered a public health priority in Europe.

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