Exploring similarities and differences in hospital adverse event rates between Norway and Sweden using Global Trigger Tool

Objectives: In this paper, we explore similarities and
differences in hospital adverse event (AE) rates
between Norway and Sweden by reviewing medical
records with the Global Trigger Tool (GTT).
Design: All acute care hospitals in both countries
performed medical record reviews, except one in
Norway. Records were randomly selected from all
eligible admissions in 2013. Eligible admissions were
patients 18 years of age or older, undergoing care with
an in-hospital stay of at least 24 hours, excluding
psychiatric and care and rehabilitation. Reviews were
done according to GTT methodology.
Setting: Similar contexts for healthcare and similar
socioeconomic and demographic characteristics have
inspired the Nordic countries to exchange experiences
from measuring and monitoring quality and patient
safety in healthcare. The co-operation has promoted
the use of GTT to monitor national and local rates of
AEs in hospital care.
Participants: 10 986 medical records were reviewed
in Norway and 19 141 medical records in Sweden.
Results: No significant difference between overall AE
rates was found between the two countries. The rate
was 13.0% (95% CI 11.7% to 14.3%) in Norway and
14.4% (95% CI 12.6% to 16.3%) in Sweden. There
were significantly higher AE rates of surgical
complications in Norwegian hospitals compared with
Swedish hospitals. Swedish hospitals had significantly
higher rates of pressure ulcers, falls and ‘other’ AEs.
Among more severe AEs, Norwegian hospitals had
significantly higher rates of surgical complications than
Swedish hospitals. Swedish hospitals had significantly
higher rates of postpartum AEs.
Conclusions: The level of patient safety in acute care
hospitals, as assessed by GTT, was essentially the
same in both countries. The differences between the
countries in the rates of several types of AEs provide
new incentives for Norwegian and Swedish governing
bodies to address patient safety issues.