ARE COMPLAINT LETTERS OF PATIENTS HELPFUL TO IMPROVE QUALITY AND SAFETY OF CARE IN A UNIVERSITY HOSPITAL? CONTRIBUTION OF THE INTERNATIONAL PATIENT CLASSIFICATION PATIENT SAFETY 2009

Purpose: Since the implementation of a law relative to patients’ right an increase in complaints for medical issues was observed in a university hospital (more than 50,000 admissions and nearly 90,000 visits to the Emergency Department each year). We decided (1) to experiment the “International Patient Classification Patient Safety 2009” (IPCPS) as a tool to analyze patient complaints; (2) to perform through these classification a first step of systemic analyses of adverse events; (3) to investigate the risk factors of perceiving a medical error or of lawsuits.     

Methods: A cross-sectional study was conducted to examine every complaint letter received by the department of Patient’s Rights (01/01/2009 - 06/30/2009). Among all these letters, only those relative to the quality and the safety of care were selected. Staff answers were also used. Socio-demographic characteristics of the writer were collected. The main event described was classified using the IPCPS.

Results: Among 104 letters, 61% were from women (median age: 44 years). According to the ICPCS, the main incident types were clinical procedures (87%), especially treatment (61%), behavior of staff and documentation, especially medical charts and delay in accessing documents. The main patient outcomes were psychological (43%) and musculoskeletal system diseases. Degree of harm was often judged moderate or severe by the patient. The investigators agreed very poorly with judgment of patients (kappa=0.25). Severe physical consequences comprising 3 deaths occurred in 58% of cases and psychological effects in 42%. Reasons for encounter the event were frequently musculoskeletal procedures. Physicians were often at the origin of complaints (50%). Contributive factors were staff factors mainly behavior (64%), performance (50%) and communication (25%) and organizational factors mainly of team (53%). Mitigating factors were directed to patients (e.g., apology). The perception of a medical error was independently associated with severe physical consequences, feeling reckless or risky behavior of the staff involved, and not following the protocol. Initiating lawsuits were independently associated with patient age over 40, with physical severe consequences and feeling medical error.

Conclusion: This study showed that ICPCS provides valuable information regarding the search for the causes of patient’s complaints. It allows to select the events that should be analyzed completely using a systemic approach to improve safety of care.