Self-reported adverse events in health care that cause harm: a population-based survey

Robert J Adams, Graeme Tucker, Kay Price, Catherine L Hill, Sarah L Appleton, David H Wilson, Anne W Taylor and Richard E Ruffin
Med J Aust 2009; 190 (9): 484-488.


Objectives: To identify the incidence of self-reported harmful adverse events in the health care of community-dwelling adults, and to examine attitudes about safety in the health system.

Design: Cross-sectional, population-based survey.

Participants and setting: Analysis of data from 3522 adults participating in Stage 2 of the North West Adelaide Health Study, who were surveyed in 2004 and 2005.

Main outcome measures: Self-reported adverse events causing harm in the past year; attitudes to safety in health care, including adequacy of current measures for preventing adverse events, and the effect of groups like patients themselves, doctors and governments on patient safety.

Results: The annual incidence of self-reported harmful adverse events was 4.2%. The main types were medication error (45.5%) and misdiagnosis or wrong treatment (25.6%). Multiple logistic regression showed that self-reported harmful adverse events were more likely in people who had been hospitalised in the past 12 months (odds ratio [OR], 2.5; 95% CI, 1.9–3.4), those who had low annual income (< $12 000), those who completed higher education to the level of Bachelor degree or higher (OR, 3.0; 95% CI, 1.0–9.4), and those who had some level of dissatisfaction with their recent health care; and less likely in those more risk-averse rather than those with a tendency to risk-taking behaviour (OR, 0.6; 95% CI, 0.4–0.9). People were more likely to believe that individual health care professionals had a positive effect on safety than professional groups or government, and that more resources were the key to improving the safety of health care.

Conclusion: We found an incidence of self-reported harmful adverse events that was significantly lower than that found by a 2002 Australian survey (4.2% v 6.5%; P = 0.009). Better communication to help patients acquire more realistic risk perception may help reduce harm. Better communication could also increase public advocacy for systems improvement in safety to counter persisting community beliefs that individual action alone can redress the situation.

  • Robert J Adams1
  • Graeme Tucker2
  • Kay Price3
  • Catherine L Hill1
  • Sarah L Appleton1
  • David H Wilson1
  • Anne W Taylor2
  • Richard E Ruffin1

  • 1 Health Observatory, Discipline of Medicine, University of Adelaide, Adelaide, SA.
  • 2 South Australian Department of Health, Adelaide, SA.
  • 3 School of Nursing and Midwifery, University of South Australia, Adelaide, SA.

Competing interests:

None identified.

  • 1. Wilson RM, Runciman WB, Gibberd RW, et al. The Quality in Australian Health Care Study. Med J Aust 1995; 163: 458-471. <MJA full text>
  • 2. Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med 1991; 324: 370-376.
  • 3. Runciman WB, Sellen A, Webb RK, et al. The Australian Incident Monitoring Study. Errors, incidents and accidents in anaesthetic practice. Anaesth Intensive Care 1993; 21: 506-519.
  • 4. Weingart SN, Callanan LD, Ship AN, Aronson MD. A physician-based voluntary reporting system for adverse events and medical errors. J Gen Intern Med 2001; 16: 809-814.
  • 5. Scott IA, Ward M. Public reporting of hospital outcomes based on administrative data: risks and opportunities. Med J Aust 2006; 184: 571-575. <MJA full text>
  • 6. Murff HJ, Patel VL, Hripcsak G, Bates DW. Detecting adverse events for patient safety research: a review of current methodologies. J Biomed Inform 2003; 36: 131-143.
  • 7. Waring JJ. A qualitative study of the intra-hospital variations in incident reporting. Int J Qual Health Care 2004; 16: 347-352.
  • 8. Woods DM, Thomas EJ, Holl JL, et al. Ambulatory care adverse events and preventable adverse events leading to a hospital admission. Qual Saf Health Care 2007; 16: 127-131.
  • 9. Vincent CA, Coulter A. Patient safety: what about the patient? Qual Saf Health Care 2002; 11: 76-80.
  • 10. Agoritas T, Bovier PA, Perneger TV. Patient reports of undesirable events during hospitalization. J Gen Intern Med 2005; 20: 922-928.
  • 11. Clark RB. Australian Patient Safety Survey. Health Issues 2001; 69: 20-24.
  • 12. National Patient Safety Foundation at the AMA [American Medical Association]. Public opinion of patient safety issues. Research findings. Boston: National Patient Safety Foundation, September 1997. (accessed Mar 2009).
  • 13. Van Der Weyden MB. The Bundaberg Hospital scandal: the need for reform in Queensland and beyond [editorial]. Med J Aust 2005; 183: 284-285. <MJA full text>
  • 14. Grant JF, Chittleborough CR, Taylor AW, et al. The North West Adelaide Health Study: detailed methods and baseline segmentation of a cohort for selected chronic diseases. Epidemiol Perspect Innov 2006; 3: 4.
  • 15. Taylor A, Wilson DH, Wakefield M. Differences in health estimates using telephones and door-to-door survey methods — a hypothetical exercise. Aust N Z J Public Health 1998; 22: 223-226.
  • 16. Australian Bureau of Statistics. Estimated resident population by age and sex in statistical local areas, Australia: data on floppy disk, Jun 1999. Canberra: ABS, 2000 (release date). (ABS Cat. No. 3227.0.)
  • 17. Australian Bureau of Statistics. Census of population and housing: selected social and housing characteristics for statistical local areas, South Australia, 2001. Canberra: ABS, 2002. (ABS Cat. No. 2015.4.) (accessed Mar 2009).
  • 18. Schoen C, Osborn R, Huynh PT, et al. Taking the pulse of health care systems: experiences of patients with health problems in six countries. Health Aff (Millwood) 2005; Jul-Dec Suppl Web Exclusives: W5-509-W5-525.
  • 19. Turner C, McClure R, Pirozzo S. Injury and risk-taking behaviour — a systematic review. Accid Anal Prev 2004; 36: 93-101.
  • 20. Weber EU, Blais AR, Betz NE. A domain-specific risk-attitude scale: measuring risk perceptions and risk behaviours. J Behav Dec Making 2002; 15: 263-290.
  • 21. Dohman T, Falk A, Huffman D, et al. Individual risk attitudes: new evidence from a large, representative, experimentally-validated survey. Bonn: Institute for the Study of Labor (IZA), September 2005. (IZA Discussion Paper No. 1730.) (accessed Mar 2009).
  • 22. Weingart SN, Gandhi TK, Seger AC, et al. Patient-reported medication symptoms in primary care. Arch Intern Med 2005; 165: 234-240.
  • 23. Weingart SN, Pagovich O, Sands DZ, et al. What can hospitalized patients tell us about adverse events? Learning from patient-reported incidents. J Gen Intern Med 2005; 20: 830-836.
  • 24. Runciman WB, Roughhead EE, Semple SJ, Adams RJ. Adverse drug events and medication errors in Australia. Int J Qual Health Care 2003; 15 Suppl 1: i49-i59.
  • 25. Dunstan DW, Zimmet PZ, Welborn TA, et al; Australian Diabetes, Obesity and Lifestyle Study (AusDiab). The Australian Diabetes, Obesity and Lifestyle Study (AusDiab) methods and response rates. Diabetes Res Clin Pract 2002; 57: 119-129.
  • 26. Taylor AW, Dal Grande E, Gill T, et al. Do people with risky behaviours participate in biomedical cohort studies? BMC Public Health 2006; 6: 11.
  • 27. Hardie EA, Critchley CR. Public perceptions of Australia’s doctors, hospitals and health care systems. Med J Aust 2008; 189: 210-214. <MJA full text>
  • 28. Wilson RMcL, Van Der Weyden MB. The safety of Australian healthcare: 10 years after QAHCS [editorial]. Med J Aust 2005; 182: 260-261. <MJA full text>
  • 29. Duckett SJ, Collins J, Kamp M, Walker K. An improvement focus in public reporting: the Queensland approach. Med J Aust 2008; 189: 616-617. <MJA full text>


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