Landmark study sheds light on veterinary patient safety events

A study of more than 64,000 incident reports from over 2,200 U.S. and European veterinary clinics revealed roughly 4 patient safety events (PSEs) for every 1,000 visits during a two-year period. While most reported incidents were harmless, the small number that caused major harm or death were often tied to anesthesia and sedation errors.

Published online on April 30 in JAVMA, the retrospective study is believed to be one of the largest of its kind in veterinary medicine. Researchers say their findings have the potential to positively influence the profession’s approach to patient care and that much can be learned from reporting systems in human health care to accelerate learning in veterinary medicine.

“This marks a significant advancement in patient safety reporting research, as our ability to analyze these events in veterinary medicine was previously restricted to a limited number of reports from individual clinics or small groups of facilities,” said Dr. Melinda Larson, lead study author and director of medical quality for BluePearl Pet Hospital, in a statement.

“Due to the extensive range of data sets, we have identified common findings that can guide us in pinpointing areas of focus most likely to enhance quality improvement and patient outcomes,” Dr. Larson added.

PSE statistics

Mars Veterinary Health and the Johns Hopkins University’s Armstrong Institute for Patient Safety and Quality analyzed the voluntary electronic incident systems of five corporate groups between January 2021 and December 2022, only counting animal-related events. A voluntary PSE is any actual or potential harm to a patient reported by veterinary medical staff of their own accord.

Falls, escapes, and other lapses in basic patient handling accounted for one-third of all veterinary PSEs followed by medication errors (26%), and anesthetic mishaps (11%). While the percentage breakdown is comparable to human medicine, researchers noted that the prominence of handling issues underscores the unpredictability of dealing with animal patients prone to bite, scratch, and flee.

Almost three-quarters of reported events either caused no harm or minor discomfort, according to the study. However, 6.1% of reported events resulted in major harm or death for the patient, with anesthesia or sedation causing nearly 1 in 4 of these outcomes, a finding consistent with decades of perianesthetic mortality work, according to the study.

Notably, the study found species is a significant factor in these incidents. For instance, cats generated 7.2 events per 1,000 visits, roughly a third more than dogs, and were more likely to be seriously harmed. Exotics, such as rabbits and reptiles, appeared in far fewer total reports but were three times more likely than dogs to suffer major-harm, a disparity the authors link to fragile physiology and scant dosing guidelines.

Voluntary reporting systems

The authors say that, given the voluntary nature of PSEs, the actual number of near misses and real harm incidents is likely higher than what they found. Clinic culture and a lack of standardization are also factors in underreporting.

One U.S. network requires every staff member to file at least one PSE a month; not surprisingly, that network logged the study’s highest event rate while another network with a more lax PSE system logged the lowest. Until the profession standardizes definitions for “visit,” “near miss,” and “harm,” true benchmarking will remain out of reach, the authors conclude.

Still, voluntary PSE reporting systems are valuable tools for identifying and correcting mistakes, thus improving patient safety and outcomes. To that end, the authors suggest clinics report every potential and real harm.

Further, anesthetic checklists and dedicated monitors are essential, according to the study’s conclusions, as are closed-loop drug protocols that require a read-back of every dose along with feline-friendly handling. Clinics that care for exotic pets are encouraged to add species-specific dosing charts onto every treatment cart or keep an exotics referral list handy.

“Data-driven decisions are important to help us focus on patient safety in the right areas and develop evidence-based solutions,” said co-author Dr. Rochelle Low, global vice president of quality and patient safety for Mars Veterinary Health. “Strong participation from so many clinics across nearly a dozen countries is an encouraging indicator that healthcare professionals worldwide recognize that improving patient outcomes requires that we normalize, encourage, and analyze patient safety reporting.”