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01.12.2012 | Research article | Ausgabe 1/2012 Open Access

BMC Health Services Research 1/2012

What is preventable harm in healthcare? A systematic review of definitions

BMC Health Services Research > Ausgabe 1/2012
Mohammed Nabhan, Tarig Elraiyah, Daniel R Brown, James Dilling, Annie LeBlanc, Victor M Montori, Timothy Morgenthaler, James Naessens, Larry Prokop, Veronique Roger, Stephen Swensen, Rodney L Thompson, M Hassan Murad
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6963-12-128) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

MHM, MN, and VL designed the study. LP performed the search strategy and retrieved the data. MN, TBE, and MHM reviewed the articles and determined eligibility for inclusion, and drafted the manuscript. TM, JD, JN, AL, SS, VR, RT, and RT made substantial contributions to the analysis and interpretation of data, as well as, drafting of the manuscript. All authors approved the final manuscript.



Mitigating or reducing the risk of harm associated with the delivery of healthcare is a policy priority. While the risk of harm can be reduced in some instances (i.e. preventable), what constitutes preventable harm remains unclear. A standardized and clear definition of preventable harm is the first step towards safer and more efficient healthcare delivery system. We aimed to summarize the definitions of preventable harm and its conceptualization in healthcare.


We conducted a comprehensive electronic search of relevant databases from January 2001 to June 2011 for publications that reported a definition of preventable harm. Only English language publications were included. Definitions were coded for common concepts and themes. We included any study type, both original studies and reviews. Two reviewers screened the references for eligibility and 28% (127/460) were finally included. Data collected from studies included study type, description of the study population and setting, and data corresponding to the outcome of interest. Three reviewers extracted the data. The level of agreement between the reviewers was calculated.


One hundred and twenty seven studies were eligible. The three most prevalent preventable harms in the included studies were: medication adverse events (33/127 studies, 26%), central line infections (7/127, 6%) and venous thromboembolism (5/127, 4%). Seven themes or definitions for preventable harm were encountered. The top three were: presence of an identifiable modifiable cause (58/132 definitions, 44%), reasonable adaptation to a process will prevent future recurrence (30/132, 23%), adherence to guidelines (22/132, 16%). Data on the validity or operational characteristic (e.g., accuracy, reproducibility) of definitions were limited.


There is limited empirical evidence of the validity and reliability of the available definitions of preventable harm, such that no single one is supported by high quality evidence. The most common definition is “presence of an identifiable, modifiable cause of harm”.
Additional file 1: Actual search strategy.(DOC 50 KB)
Additional file 2: Table S1.Characteristics of included publications. (DOC 678 KB)
Additional file 3: Table S2. Number of articles reported under each definition, broken up by the type of harm. (DOCX 17 KB)
Authors’ original file for figure 1
Authors’ original file for figure 2
Authors’ original file for figure 3
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