While healthcare has brought enormous benefits to mankind, it is not without risks. Adverse events due to unsafe care are one of the 10 leading causes of death and disability globally. The World Health Organisation (WHO) estimates that there is a one-in-3,000,000 risk of dying while travelling by airplane.
In contrast, the risk of dying due to a preventable medical accident while receiving health care, is estimated to be one in 300. In fact, as many as one in every 10 patients is harmed while receiving hospital care in high-income countries.
WHO estimates that 134 million adverse events occur annually due to unsafe care in hospitals in low- and middle-income countries, contributing to 2.6 million deaths annually and the harming of every four out of 10 patients in primary and ambulatory settings, of which up to 80% of cases could have been avoided.
In addition, 15% of hospital expenses can be attributed to treating patient safety failures in OECD countries. The global cost associated with medication errors has been estimated at US$42 billion (RM175.3 billion) annually, not taking into account lost wages, productivity and healthcare costs.
Of every 100 hospitalised patients, seven in high-income countries and 10 in low- and middle-income countries acquire one or more healthcare-associated infections (HAIs). Regardless of income level, different interventions, including hand hygiene, can reduce HAI rates by up to 55%.
Unsafe surgery can cause complications in up to a quarter of patients. Although deaths from such complications have reduced markedly, they are still two to three times higher in low- and middle-income countries than in high-income countries.
The aviation and nuclear industries, which are perceived to have high risk, actually have a much better record than healthcare. There were 5,689 incident reports (1,923 mandatory and 3,766 voluntary) from 120 (83.9%) Health Ministry hospitals in 2017.
Of the cases considered as severe, there were 191 patient falls, 86 medication errors, 62 adverse outcomes of clinical procedures, 46 catheter dislodgements and 39 injuries to neonates (babies up to one month of age).
In a 2012 review of 1,753 randomly-selected medical records from 12 local public primary care clinics in 2007, published in the BMC Family Practice journal, management errors were found in over half (53.2%) of cases. Of these, around two in five errors (39.9%) had the potential to cause serious harm and 93.5% of cases were considered preventable.
Although there is no published data from the private sector, only the very brave will dare claim that their incidence of adverse events is lower than that of the public sector.
The reason for adverse events in healthcare was summed up succinctly by British paediatric nephrologist Sir Dr Cyril Chantler, who stated in 1998: “Medicine used to be simple, ineffective and relatively safe. It is now complex, effective and potentially dangerous.”
Patient safety to the fore
This issue has become so important that the WHO is launching the first-ever World Patient Safety Day today (Sept 17, 2019). The theme of the day is “Patient Safety: A global health priority” and the slogan is “Speak up for patient safety”.
This new international day is being introduced as part of WHO’s campaign to create awareness of patient safety and urge everyone to show their commitment to making healthcare safer.
The objective of the campaign is to mobilise patients, health workers, policymakers, academics, researchers, professional networks and the healthcare industry to speak up for patient safety. Everyone can enhance patient safety, depending on one’s circumstances.
Patients should be actively involved in their healthcare; ask questions, as safe healthcare starts with good communication; and ensure that accurate information about their health history is provided to their healthcare providers, whether they be doctors, dentists, nurses, pharmacists etc.
The same applies to caregivers. Greater patient involvement is the key to safer care. WHO estimates that if done well, it can reduce the burden of harm by 15%.
Healthcare providers and managers should engage patients as partners in their care; work together for patient safety; ensure continuous professional development to improve personal skills and knowledge in patient safety; create an open and transparent safety culture in healthcare settings; and encourage blame-free reporting of, and learning from, errors.
Policymakers should always recognise that investing in patient safety results in financial savings, saves lives and builds trust, and make patient safety a national health priority.
The cost of prevention is considerably less than the cost of treatment caused by harm. For example, safety improvements led to US$28bil (RM116.8bil) in savings in US Medicare hospitals between 2010 and 2015.
Public health advocates and patient organisations should always promote patients’ voices in their own care and advocate for safety in healthcare as a
fundamental requirement in healthcare.
Professional associations and academia should promote patient safety for achie-ving universal health coverage; provide learning and development opportunities for patient safety; include patient safety in educational curricula and courses; and generate research evidence to improve patient safety.
Much can be done by everyone – not just patients – simply because everyone is a potential patient. Through the joint efforts of everyone, healthcare can become safer.
To commemorate the day, the Malaysian Society for Quality in Health and the Health Ministry are organising a seminar and forum, with the theme “Speak up for Patient Safety”, at the Everly Hotel, Putrajaya, today (Sept 17, 2019).