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New 10-year patient safety analysis highlights areas for improvement in acute medical units

Recommendations from a new 10-year analysis of patient safety incidents in hospital acute medical units across England and Wales include the introduction of electronic prescribing and monitoring systems, checklists to reduce diagnostic errors, and an increased presence of senior clinicians and pharmacists overnight and at the weekends to reduce the vulnerability of less experienced staff.

The research, by Cardiff University and University College London, published today in the Journal of the Royal Society of Medicine, is the first analysis of all the severe harm and death incident reports occurring in acute medical units in England and Wales. It shows the most common incident types were diagnostic errors, medication-related errors and failures in monitoring patients.

Acute medical units were introduced in 2004 to relieve pressures on emergency departments and improve patient outcomes, but little is known about patient safety incidents occurring in the units.

The researchers analysed 377 acute medical unit incidents reported to the National Reporting and Learning System for England and Wales which led to severe harm or death between 2005 and 2015. Diagnostic error was the most common incident type, with delayed diagnosis the most common diagnostic error, and cancer the most commonly missed diagnosis.

The research shows that patients were at a higher risk of patient safety incidents when there were multiple handovers between teams; transfers between wards; and the out-of-hours settings including during the night.

Lead researcher Dr Andrew Carson-Stevens, Clinical Reader in Patient Safety and Quality Improvement at Cardiff University's School of Medicine, and lead for patient safety research at PRIME Centre Wales, said: “The reports in this study came from frontline healthcare professionals over a 10-year period and our detailed analysis highlights where acute medical units can review their existing systems to ensure they are as safe as possible.” He continued: “The learning from these incident reports represents an invaluable opportunity to improve the safety of acute medical units for future patients. The NHS also stands to improve overall staff well-being by using the insights to design work environments that maximise their performance and mitigate risks resulting in unsafe care outcomes in this often high-pressured care setting.”

One of the themes running through the incident reports was the dependence on individual people for patient advocacy to remind staff about investigations or referrals. Another of the researchers, Dr Sarah Yardley, of University College London, said: “Patients who were unable to self-advocate due to their illness or other vulnerabilities were often overlooked due to system pressures and may be most at risk.”

Notes to editors

Learning from patient safety incidents involving acutely sick adults in hospital assessment units in England and Wales: a mixed methods analysis for quality improvement (DOI: 10.1177/01410768211032589) by Alexandra Urquhart, Sarah Yardley, Elin Thomas, Liam Donaldson, and Andrew Carson-Stevens, will be published by the Journal of the Royal Society of Medicine at 00:05 hrs (UK time) on Thursday 5 August 2021.

The link for the full text of the paper is:

For further information or a copy of the paper please contact:

Rosalind Dewar
Media Office, Royal Society of Medicine
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The Journal of the Royal Society of Medicine (JRSM) is a leading voice in the UK and internationally for medicine and healthcare. Published continuously since 1809, JRSM features scholarly comment and clinical research. JRSM is editorially independent from the Royal Society of Medicine, and its editor is Dr Kamran Abbasi.

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Cardiff University is recognised in independent government assessments as one of Britain’s leading teaching and research universities and is a member of the Russell Group of the UK’s most research-intensive universities. The 2014 Research Excellence Framework ranked the University 5th in the UK for research excellence. Among its academic staff are two Nobel Laureates, including the winner of the 2007 Nobel Prize for Medicine, Professor Sir Martin Evans. Founded by Royal Charter in 1883, today the University combines impressive modern facilities and a dynamic approach to teaching and research. The University’s breadth of expertise encompasses: the College of Arts, Humanities and Social Sciences; the College of Biomedical and Life Sciences; and the College of Physical Sciences and Engineering, along with a longstanding commitment to lifelong learning. Cardiff’s flagship Research Institutes are offering radical new approaches to pressing global problems. More at

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