2021_Book_TextbookOfPatientSafetyAndClin

Patient Safety in Internal Medicine
Micaela La Regina, Alessandra Vecchié,
Aldo Bonaventura, and Domenico Prisco
17
Learning Objectives/Questions Covered in
the Chapter
• How many are the adverse events (AEs) in
Internal Medicine (IM)?
• What are the most frequent errors?
• How to prevent medication or identification
errors?
• How to prevent AEs in invasive procedures in
IM?
• How to prevent clinical reasoning errors?
• How to improve team working and communication
among health operators in IM?
• What are the safety practices to be implemented
in IM?
M. L. Regina (*)
S.S. Risk Management, ASL5 Liguria,
La Spezia, Italy
e-mail: micaela.laregina@asl5.liguria.it
A. Vecchié
Pauley Heart Center, Division of Cardiology,
Department of Internal Medicine, Virginia
Commonwealth University, Richmond, VA, USA
A. Bonaventura
Pauley Heart Center, Division of Cardiology,
Department of Internal Medicine, Virginia
Commonwealth University, Richmond, VA, USA
First Clinic of Internal Medicine, Department of
Internal Medicine, University of Genoa, Genoa, Italy
D. Prisco
Department of Experimental and Clinical Medicine,
University of Florence, Florence, Italy
e-mail: domenico.prisco@unifi.it
17.1 Epidemiology of Adverse
Events
There are few specific studies on epidemiology
of AEs in IM. Most of them are focused on particular
events, such as medication, interventional
procedures, or diagnostic reasoning errors.
The first historical study conducted in IM was
that by Schimmel in 1960 [1]. He found that 20%
of patients admitted to a university medical service
in USA experienced one or more untoward “iatrogenic”
episodes. Anyway, such pioneering study
was not based on the current definition of AE and
reported only drug reactions and untoward effects
of diagnostic and therapeutic procedures — the
so-called diseases of medical progresses, the price
to pay for modern medical care [2, 3]. Twenty
years later, Steel et al. [4] reported a rate of 36%
AEs in the medical service of a teaching hospital.
Then, the Harvard Medical Practice Study I [5]
found a rate of AEs of 3.6 ± 0.3% (30.9 ± 4.4% of
them due to negligence) in IM and 7 ± 0.5%
(28 ± 3.4% of them due to negligence) in general
surgery, and the Quality in Australian Healthcare
Study (QAHCS) displayed an incidence of 6.6%
in IM versus 13.8% in general surgery [6]. More
recently, studies from the UK [7], the USA [8],
Portugal [9], and Spain [10] reported an incidence
ranging from 10% to 23.2%. Fatality ranges from
2% [2] to 20% [6] in the various studies. Such
large variability of incidence and severity can
depend on differences in AEs definition, settings
© The Author(s) 2021
L. Donaldson et al. (eds.), Textbook of Patient Safety and Clinical Risk Management,
https://doi.org/10.1007/978-3-030-59403-9_17
213