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LEGAL: Preventable medical errors contribute to between 9,250 and 23,750 deaths in Canada a year, a landmark study of what the medical community calls "adverse events" suggests. - Toronto Star

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Pubdate: May 22, 2004. 02:48 PM
Source: The Toronto Star
Author: Helen Branswell
CANADIAN PRESS



Medical errors kill thousands annually: Study


Some facts from the Canadian adverse events study, to be published Tuesday in the Canadian Medical Association Journal:

  • One in 13 people who go into hospital suffer an adverse event.
  • Based on 2.5 million admissions in 2000, that means 140,000 to 232,000 people experienced adverse events.
  • 37 per cent of those were preventable.
  • Adverse events added an average of six days to a hospital stay.
  • One in five people who had an adverse event went on to die; nine per cent of these adverse events were categorized as highly preventable.
  • The most common types of adverse events related to surgeries, followed by drug- or fluid-related events.

Source: The Canadian Press

Preventable medical errors contribute to between 9,250 and 23,750 deaths in Canada a year, a landmark study of what the medical community calls "adverse events" suggests.

The first national attempt to quantify the scope of the problem, it found that one in 13 or 7.5 per cent of patients who received care in hospitals suffered an adverse event in 2000 and 37 per cent of those were preventable.

Adverse events ranged from an abdominal aneurysm that was diagnosed as kidney stones (the patient died) to a missed but obvious case of uterine cancer, to the unscheduled removal of ovaries in what was meant to be a partial hysterectomy.

The authors cautioned that a causal link can't always be drawn between the adverse events and the deaths.

"We're saying the adverse events were preventable, and in some cases they led to death," said co-lead author Ross Baker.

"We're not trying to avoid the issue that a number of people probably larger than most people think die in Canadian hospitals and that they also experience adverse events," he said. "And we need to improve the system so it's a safer environment for them to receive care."

Making those changes will be tough in a climate where fessing up to a mistake could land someone in court, Baker admitted.

"The fear that health professionals have that what they do will lead to potential lawsuits leads to a tendency to cover up rather than to report things that go wrong," said Baker, adding that until it's clear where the problems are occurring, the system can't be fixed.

"So that's the Number 1 issue."

Baker's co-author admitted the numbers were likely on the low side, because a review of hospital charts the methodology used cannot catch all cases. For instance, a wound infection that wasn't detected until the patient went home might never be noted on a hospital chart, said Dr. Peter Norton, a patient safety expert at the University of Calgary.

System-wide effort will be needed to reduce the number of preventable adverse events, they said, suggesting that better communication among doctors, nurses and pharmacists as well as the adoption of electronic medical records would lead to improved patient safety.

"We will never eliminate some adverse events, because the science doesn't give us all the tools that we need," said Baker, a professor in the University of Toronto's department of health policy, management and evaluation.

"We certainly hope to move down the numbers of preventable events a lot farther than they are right now."

The president of the Canadian Medical Association called the findings "a wake-up call" for the health-care professions.

"The report is a stark reminder that much remains to be done in improving patient safety in this country," said Dr. Sunil Patel. "The warning light is flashing. And we just cannot ignore it."

Baker, Norton and a large team of researchers from seven universities across the country undertook the study with funding from the Canadian Institutes of Health Research and the Canadian Institute for Health Information. It is to be published Tuesday in the Canadian Medical Association Journal.

They conducted chart reviews of a random sample of 3,720 patients from 20 hospitals in five provinces British Columbia, Alberta, Ontario, Quebec and Nova Scotia. In each province, a teaching hospital, a large community hospital and two small community hospitals were randomly selected for review.

Teaching hospitals had the highest rates of adverse events, probably because they see the most complex cases, the authors said. But their rates of preventable adverse events were in line with those of the community hospitals.

"We believe this indicates that the quality of care given in these three sectors of our hospital system are the same," Norton said.

Adverse events added an average of six days to hospital stays. Older people were at greater risk of experiencing an adverse event than other patients.

The chair of the newly established Canadian Institute for Patient Safety admitted that as a consumer of health care, he'd find the numbers a bit concerning.

"And yet my experience is the Canadian health-care system is among the world's best and among the safest in the world," said Dr. John Wade, an anesthesiologist from Winnipeg.

Wade welcomed the study, which he said will help hospitals home in on where errors are being made so they can improve systems.

The head of risk management and quality improvement at St. Michael's Hospital in Toronto agreed. Pat McKernan said hospitals have been working on improving patient safety for some time, but seeing where the problems are helps focus that work.

"I would see it as helping us to continue to formalize our study and our analysis of patient care outcomes negative outcomes and make the necessary changes to either prevent or significantly reduce those events occurring in the future," she said.

Wade expressed some concern the data in the study might be used as ammunition by proponents of an American-style, for-profit health-care system.

That's because the Canadian incidence rate of 7.5 per cent is higher than those found in two earlier U.S. studies 2.9 and 3.7 per cent respectively. The Canadian rate was lower than those found in similar studies in Britain (10.8 per cent), Australia (16.6 per cent) and New Zealand (12.9 per cent).

Baker said the American studies focused on major adverse events and probably didn't include the full range of errors that would have been captured by the other international studies.

A researcher who has done work on adverse events raised another fear. Dr. Alan Forster of the Ottawa Health Research Institute said he worries some people may be tempted to avoid seeking needed care after seeing the scope of the problem.

"There needs to be caution that this doesn't turn people away from care that is necessary," he said in an interview, noting that while adverse events can be dangerous, not seeking care at all is a greater threat to patient health.

----End of Article-----

Canadians have every right to be outraged that they are paying for an inadequate, dangerous health system which they have been abandoning in ever-increasing numbers and turning to safer, cheaper practices and therapies for non-emegencies and the treatment of disease.

Consumers must pay out-of-pocket for almost every natural, holistic remedy or therapy, which excludes many Canadians who can not afford them, and establishes a larger two-tier system than anticipated. Those excluded are at the mercy of the status quo and many become some of the unnecessary statistics.

We must put unprecedented pressure on politicians to a) legalize and regulate all currently prohibited herbs, and integrate natural, holistic remedies or therapies into the universal system, b) deflate police budgets and increase health budgets to protect us in the most significant way possible.

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Last Modified:Sunday, 23-May-2004 19:16:44 PDT 17471