| Canada,
about 185,000 are associated with an adverse events and close to 70,000
of those are potentially preventable.
Patient safety is receiving
growing attention in Canada. Numerous legal cases and media stories
have highlighted the consequences of unintended adverse events. In 2002
the Canadian government budgeted $50 million over 5 years for the
creation of the Canadian Patient Safety Institute, and many health care
organizations have now initiated efforts to improve patient safety.
One important indicator of
patient safety is the rate of adverse events among hospital patients.
Adverse events are unintended injuries or complications that are caused
by health care management, rather than by the patient’s
underlying disease, and that lead to death, disability and the time of
discharge or prolonged hospital stays. The study defines disability to
mean a temporary impairment of function lasting up to a year, permanent
impairment of function or death. The study found that 37%-51% of
adverse events have been judged in retrospect to have been potentially
preventable.
Hospital admissions with a most
responsible diagnosis related to obstetrics or psychiatry were
excluded. This is of significance as adverse events arising in the
practice of obstetrics can result in greater economic loss claims.
Of particular note the study
found that of the patients who experienced adverse events, 41.6% were
judged to have 1 or more adverse events with a high preventability
rating. In 15.3% of the patients, preventability was judged to be
“virtually certain.” The sad finding of the study
was that death was estimated to have occurred in 20.8% of those adverse
events and 9% of these adverse events were judged to have been highly
preventable. Preventable adverse events were similar across all
hospital types, ranging from large community hospitals to small and
teaching hospitals. Furthermore, 5.2% of the adverse events resulted in
permanent disability, and 15.9% resulted in death.
The degree of disability
required consideration of the patient’s potential for work
and activities of daily living. The most common types of adverse events
were related to surgical procedures, and the next most common were
associated with drug or fluid-related events.
The study showed that an
estimated 7.5% of patients admitted to acute care hospitals in Canada
experienced 1 or more adverse events. 36.9% of these patients were
judged to have highly preventable adverse events. It was estimated a
small but significant proportion of patients died or experienced
permanent disability as a result of their adverse events. The study
found that in 2000, between 141,250 and 232,250 admissions to acute
care hospitals in Canada were associated with an adverse event and that
9,250 to 23,750 deaths from adverse events could have been prevented.
Extrapolating the figures, found
in the study, the Canadian Institute for Health Information stated that
patients spend more than 1 million extra days in hospital being treated
for injuries or complications in their care.
The high number of errors
surprised Michael Decter, head of the Health Council of Canada.
“We knew we had a problem, we didn’t know how big
it was. Now that we know…, we’ve got a lot of work
to do.”
One in 9 adults with health
problems reported receiving the wrong medication or dose. The same
number contacted an infection such as pneumonia while in hospital, the
report said.
Figures on birth trauma were
presented for the first time. One in 81 babies born vaginally suffers
an injury, which can range from mild bruising to severe brain damage
the report said.
In the United States, a recent
study done by the HealthGrades Inc. of Colorado estimates that as many
as 195,000 people a year could be dying in U.S. hospitals because of
easily preventable errors. This estimate doubles previous figures. The
HealthGrades Inc. said its data covers all 50 states and is more
up-to-date than a 1999 study from the Institute of Medicine that said
98,000 people a year die from medical errors.
The HeathGrades Inc. study
includes as mistakes, failure to rescue dying patients and the death of
low-risk patients from infections. It said it found about 1.14 million
“patient-safety incidents” occurred among the 37
million hospitalizations. Of the total deaths among patients who
developed patient-safety incidents, 81 percent of these deaths were
directly attributable to the incidents. In fact, approximately one in
every four patients who were hospitalized and experienced a
patient-safety incident died.
The U.S. government is trying to
spearhead a move to get hospitals and clinics to use electronic
databases and prescribing methods as an earlier study by the Institute
of Medicine report said many deaths were due to medication prescribing
errors or to errors in delivering medications.
The study concluded that if the
Centres for Disease Control and Prevention’s annual list of
leading causes of death included medical errors, it would show up as
number six, ahead of diabetes, pneumonia, Alzheimer’s disease
and renal disease.
An earlier and seminal study
done by the Harvard Medical Practice Study Group determined that for
every 8 potential medical malpractice claims, only 1 claim was actually
filed.
This study (generally known as
the Harvard study) commissioned by New York state in 1986, and released
in 1990, showed that actual malpractice is relatively rare. Of the New
York hospital cases examined, the incidence of adverse events, or
injuries resulting from medical “interventions” or
treatment, was 3.7 percent. The percentage of adverse events due to
what the physician team characterized as
“negligence” (not necessarily a legal definition)
was 1 percent. However, only one in eight who suffered from an adverse
event due to negligence filed a medical malpractice claim, and only one
in 15 received compensation. Most adverse events resulted in only
minimal and transient disability. This helps to explain why only a
small percentage of patients who are injured as a result of negligence
file medical malpractice claims. However, a significant portion (22
percent) of patients who did not file medical malpractice claim
suffered moderate or greater incapacity.
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