The annual rate of serious safety events reported by healthcare organizations to The Joint Commission rose by 19% in 2022. The uptick is mostly attributable to falls, which increased by 27% overall, according to the authors of the Sentinel Event Data 2022 Annual Review.
The Joint Commission’s yearly review provides data on adverse safety events with the aim of encouraging safety improvements. The data are self-reported and most of the events in the latest update, released April 6, occurred in hospitals (88%). Additional reporting came from home care, behavioral health, ambulatory care and critical access hospital organizations.
Home care setting
Patient falls were the most commonly reported adverse event overall (42%). But in the home care setting, fires were the leading adverse event type (43%) from incidents such as smoking while receiving oxygen, while patient falls accounted for 20% of events.
Overall, most falls occurred while ambulating (40%) followed by falling from bed (23%) and falling while toileting (10%). Other leading adverse safety events included delay in treatment (6%), unintended retention of foreign object (6%), wrong surgery (6%) and suicide (5%).
“Of all the sentinel events, 20% were associated with patient death, 44% with severe temporary harm and 13% with unexpected additional care/extended stay,” The Joint Commission stated.
Last year’s rise in falls is likely associated with ongoing pandemic challenges, the review’s authors theorized. The data also revealed potential failures in communications, teamwork and consistency in following established policies.
Since the data is self-reported, “no conclusions should be drawn about the actual relative frequency of events or trends in events over time,” the authors noted.
An overview of the Sentinel Event Data 2022 Annual Review can be found on the organization’s website.
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