The Global Trigger Tool shows that one out of seven patients suffers harm in Palestinian hospitals: challenges for launching a strategic safety plan

Objective. The aim of this study was to evaluate patient safety levels in Palestinian hospitals and to provide guidance for policymakers involved in safety improvement efforts. Design. Retrospective review of hospitalized patient records using the Global Trigger Tool. Setting. Two large hospitals in Palestine: a referral teaching hospital and a nonprofit, non-governmental hospital. Participants. A total of 640 random records of discharged patients were reviewed by experienced nurses and physicians from the selected hospitals. Intervention. Assessment of adverse events. Main Outcome Measures. Prevalence of adverse events, their preventability and harm category. Descriptive statistics and Cohen kappa coefficients were calculated. Results. One out of seven patients (91 [14.2%]) suffered harm. Fifty-four (59.3%) of these events were preventable; 64 (70.4%) resulted in temporary harm, requiring prolonged hospitalization. Good reliability was achieved among the independent reviewers in identifying adverse events. The Global Trigger Tool showed that adverse events in Palestinian hospitals likely occur at a rate of 20 times higher than previously reported. Although reviewers reported that detecting adverse events was feasible, we identified conditions suggesting that the tool may be challenging to use in daily practice. Conclusion. One out of seven patients suffers harm in Palestinian hospitals. Compromised safety represents serious problems for patients, hospitals and governments and should be a high priority public health issue. We argue that direct interventions should be launched immediately to improve safety. Additional costs associated with combating adverse events should be taken into consideration, especially in regions with limited resources, as in Palestine.