Hospital deaths and adverse events in Brazil

<p>Abstract</p> <p>Background</p> <p>Adverse events are considered a major international problem related to the performance of health systems. Evaluating the occurrence of adverse events involves, as any other outcome measure, determining the extent to which the observed differences can be attributed to the patient's risk factors or to variations in the treatment process, and this in turn highlights the importance of measuring differences in the severity of the cases. The current study aims to evaluate the association between deaths and adverse events, adjusted according to patient risk factors.</p> <p>Methods</p> <p>The study is based on a random sample of 1103 patient charts from hospitalizations in the year 2003 in 3 teaching hospitals in the state of Rio de Janeiro, Brazil. The methodology involved a retrospective review of patient charts in two stages - screening phase and evaluation phase. Logistic regression was used to evaluate the relationship between hospital deaths and adverse events.</p> <p>Results</p> <p>The overall mortality rate was 8.5%, while the rate related to the occurrence of an adverse event was 2.9% (32/1103) and that related to preventable adverse events was 2.3% (25/1103). Among the 94 deaths analyzed, 34% were related to cases involving adverse events, and 26.6% of deaths occurred in cases whose adverse events were considered preventable. The models tested showed good discriminatory capacity. The unadjusted odds ratio (OR 11.43) and the odds ratio adjusted for patient risk factors (OR 8.23) between death and preventable adverse event were high.</p> <p>Conclusions</p> <p>Despite discussions in the literature regarding the limitations of evaluating preventable adverse events based on peer review, the results presented here emphasize that adverse events are not only prevalent, but are associated with serious harm and even death. These results also highlight the importance of risk adjustment and multivariate models in the study of adverse events.</p

Características de eventos adversos evitáveis em hospitais do Rio de Janeiro

OBJETIVO: Analisar as características dos eventos adversos (EAs) evitáveis em pacientes internados em hospitais do Rio de Janeiro, com vista a identificar elementos que sirvam de substrato à ações prioritariamente voltadas para melhoria da segurança do paciente. MÉTODOS: Análise de dados coletados no estudo de base de coorte retrospectivo para avaliação da ocorrência de EAs em uma amostra de prontuários em três hospitais de ensino do estado do Rio de Janeiro para descrever as características dos EAs evitáveis. RESULTADOS: Na amostra de 1.103 pacientes foram identificados 65 EAs evitáveis dos 56 pacientes que sofreram EAs evitáveis. As infecções associadas aos cuidados da saúde (IACS) representaram 24,6%; complicações cirúrgicas e/ou anestésicas, 20,0%; danos decorrentes do atraso ou falha no diagnóstico e/ou tratamento, 18,4%; úlceras por pressão, 18,4%; danos de complicações na punção venosa, 7,7%; danos devido a quedas, 6,2%; danos em consequência do emprego de medicamentos, 4,6%. EAs evitáveis foram responsáveis por 373 dias adicionais de permanência no hospital. CONCLUSÃO: O estudo mostrou que os EAs mais frequentes são as IACS, tal como observado em outros países em desenvolvimento. Apesar das limitações do estudo, a descrição da caracterização dos EAs evitáveis indica que ações disponíveis e consagradas voltadas para diminuir as IACS, como a higienização das mãos, a prevenção a úlcera por pressão, o estímulo a adesão a protocolo e diretrizes clínicas e o estabelecimento de programas de educação continuada de profissionais de saúde, devem compor a lista de prioridades dos gestores hospitalares e dos profissionais de saúde envolvidos no cuidado ao paciente hospitalizado

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data