Emergency Department and hospital adverse events in Aotearoa New Zealand

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This is a multicentre, prospective cohort study of ED Adverse Events (AEs) in 6,336 eligible patients from 9 NZ Emergency Departments(EDs) presenting over 1 year. A stratified cluster sampling scheme will be used to randomly select 18 shifts within each ED in which to enroll patients. At each ED, trained research assistants will be present for each randomised shift, and will aim to enroll and prospectively consent consecutive patients presenting to the ED who are not critically unwell. For these patients, research assistants will collect baseline patient and systems data, and will contact enrolled patients 21 days after this index visit for a follow-up phone-call interview using a structured questionnaire aiming to identify outcomes of interest or AE triggers. A 21 day follow-up phone interview was chosen because previous international studies suggest that consumers can reliably report AEs, and the majority of ED AEs occur within 72 hours of the ED visit, with the remainder by 3 weeks. For critically unwell patients, approach for enrollment/consent will be deferred until patient has improved. For deceased patients baseline data will be collected as per clinical audit and HQSC processes, and the medical records will be reviewed for AE triggers. Admitted patients will also have medical records examined for AE triggers. Once research nurses have finished the interviews and review of medical records, for those patients who have an AE trigger or flagged outcome present, clinical summaries will be created, and these will be examined by the emergency physician reviewers to determine presence of AEs, and their classification and preventability. The primary objective is to estimate the frequency of ED AEs by calculate an event rate . Secondary outcomes include assessing types, severity and preventability of AEs, as well as patient and system factors associated with AEs.

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