58 Chapter 4 performed using patient admissions from1 April 2011 until 31 March 2012, in 20 hospitals, out of the total of 93 Dutch hospitals. The sample was stratified for university, tertiary teaching and general hospitals. Within the strata the hospitals were selected randomly and a proper representation of both urban and rural settings in the sample was verified. Hospitals had to have at least 200 beds, an intensive care unit and an emergency room to be eligible. Therefore, four hospitals were excluded, leaving 89 hospitals from which the sample was drawn. In each hospital, 200 patient admissions were selected. In total 4,048 patient admissions were included. Patients admitted to the psychiatry department, obstetrics and children under 1 year were excluded to be comparable with other studies using the same review methods. Fifty percent of the records were of patients who were discharged from the hospital after a stay of at least 24 hours. The other 50% were of patients who died in hospital during admission. This made it possible to estimate the number of preventable deaths as this is a relatively small patient group. These patients were sampled from all inpatient deaths, regardless of their length of stay (LOS). The method of determining AEs was comparable to those of other international studies. First, a nurse screened the records by using triggers indicating potential AEs. Admissions that were positive for at least one trigger were reviewed further by a physician. The presence and preventability of an AE was determined based on a standardized procedure and preceded by several underlying questions to secure a systematic assessment. An AE was defined by three criteria: • an unintended injury; • the injury resulting in a longer hospital stay, temporary or permanent disability, or death; • the injury was caused by healthcare management rather than the patient’s disease. An AE was found to be preventable when the care given fell below the current level of expected performance for practitioners or systems. The causation by healthcare of an AE as well as its preventability was scored on a six-point ‘Likert Scale’ after consideration through a set of supportive questions to standardize the procedure. This score is counted as caused by healthcare or preventable if the score was 4–6. A score of 4–6 indicated that the reviewer regarded the event as having a >50% chance of being caused by healthcare or being preventable. The physicians assessed the clinical process that was related to
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