Most
is drug-related and accounts for $9.3 billion excess charges in US
BMJ
Around
one in 20 (6%) of patients are affected by preventable harm in medical care, of
which around 12% causes permanent disability or death, finds a study published
by The BMJ today.
Most
preventable harm relates to drug incidents and invasive procedures and it is
more common in surgical and intensive care units than in general hospitals.
Preventable
harm also accounts for an estimated $9.3 billion (£7.3bn; €8.2bn) excess
charges in the US. Similarly, the financial cost from only six selected types
of preventable patient harms in English hospitals is equivalent to over 2000
salaried general practitioners or over 3500 hospital nurses each year.
As
such, the researchers say strategies targeting preventable patient harm could
lead to major improvements in medical care and considerable cost savings for
healthcare systems across the globe.
Preventable patient harm is a serious problem across medical care settings globally, and early detection and prevention is an international policy priority. Several previous reviews have examined overall patient harm across different settings, but none have focused on preventable patient harm.
So a team of researchers led by Maria Panagioti from the NIHR Greater Manchester Patient Safety Translational Research Centre set out to measure the prevalence of preventable patient harm across a range of medical settings, including hospitals and in primary care. They also examined the severity and most common types of preventable patient harm.
Their
findings are based on data from 70 observational studies involving 337,025
mostly adult patients. Of these, 28,150 experienced harmful incidents and
15,419 experienced preventable harmful incidents.
Around
12% of the preventable harm was severe (causing prolonged, permanent disability
or death), while incidents relating to drugs and other treatments accounted for
almost half (49%) of preventable harm.
Compared
with general hospitals, preventable harm was more common in patients treated in
surgical and intensive care units, and was lowest in obstetric units.
Despite
the unique focus on preventable patient harm and several method strengths, this
review has some limitations, say the authors. For example, variations in study
design and quality of documentation used for detecting preventable patient harm
may have led to differences in prevalence estimates.
Nevertheless,
they say their findings "affirm that preventable patient harm is a serious
problem across medical care settings" and "priority areas are the
mitigation of major sources of preventable patient harm (such as drug
incidents) and greater focus on advanced medical specialties."
It
is equally imperative to build evidence across specialties such as primary care
and psychiatry, vulnerable patient groups, and developing countries, they add.
"Improving the assessment and reporting standards of preventability in
future studies is critical for reducing patient harm in medical care
settings," they conclude.
This
view is supported by experts at the London School of Economics and Harvard
Medical School in a linked editorial.
They
say this study "serves as a reminder of the extent to which medical harm
is prevalent across health systems, and, importantly, draws attention to how
much is potentially preventable."
Moving
forward, they say "efforts need to be focused on improving the ability to
measure preventable harm. This includes fostering a culture that allows for
more systematic capturing of near misses, identifying harm across multiple care
settings and countries, and empowering patients to help ensure a safe and
effective health system."