Patient safety in Canadian hospitals is slow to improve, report says
Eleven years after the release of an eye-popping study showing 185,000 Canadian patients suffered unintended harm while in hospital, a followup report reveals progress on improving patient safety has been slow.
“It’s sobering because we thought we understood what had to be done (11) years ago. What we realize in retrospect is that we only understood part of the puzzle,” said Ross Baker, co-author of both studies and professor at the University of Toronto’s Institutes of Health Policy, Management and Evaluation.
His seminal study on medical errors in hospitals, the 2004 Canadian Adverse Events Study, found that 7.5 per cent of adult patients suffer from mistakes made by health professionals. Almost 40 per cent of errors are potentially preventable. Between 9,000 and 23,000 patients died annually from preventable error.
Errors include: medication overdoses, surgical complications, patient falls, pressure ulcers and infections related to insufficient infection control.
The followup report, Beyond the Quick Fix, was prepared in conjunc- tion with KPMG and concludes there has been only “limited improvement” in patient safety. The health system should be safer than it is, given 11 years of effort and tens of millions of dollars of investment, it says.
“Many Canadian health care organizations still struggle to address patient safety issues. Harm experienced by patients . . . continues despite better measures of the number and impact of these events and efforts to change unsafe practices,” it reads. The latest report is based on findings from a number of provincial studies as well as research from jurisdictions around the world with similar health systems.
A study published last year in the New England Journal of Medicine found that Ontario hospitals saw no measurable improvements in patient outcomes when using surgical checklists. An accompanying editorial stated the likely reason for the failure is that the checklists aren’t actually used.
Checklists require, for example, that staff confirm all instruments and sponges are accounted for.
A recent analysis by Health Quality Ontario found that the percentage of falls in complex continuing care hos- pitals actually jumped to 10.4 per cent in 2012/13 from 9.3 per cent in 2009/10 despite efforts to keep patients safe.
Ontario health ministry data shows there has been next to no change in the rate of hospital acquired C. difficile between 2009/10 and 2014/15, despite attempts to lower the infection rate. The new report notes that many patient-safety interventions add work for health professionals without regard to workload. A 2013 U.S. study published in the British Medical Journal notes that nurses are expected to spend an extra 115 minutes per patient per day to complete tasks to help lessen the chance of patients getting ventilator-associated pneumonia.
Baker said it’s unrealistic to issue edicts to clinicians to undertake time-consuming patient-safety measures at a time when hospitals are being squeezed for resources and are seeing sicker patients.