Introduction by Croakey: The COVID-19 pandemic has, among much else, brought home the real risk of patient harm, according to a new report for the Organisation for Economic Co-operation and Development (OECD), which found the estimated proportion of hospital-acquired COVID-19 cases ranges from 12.5 per cent to 44 per cent.
But at any time, unsafe care kills millions, and harms tens of millions of people each year, and also exerts a great economic cost on health systems and society, according to the report: The economics of patient safety: from analysis to action.
Lead author, Australian health economist Luke Slawomirski, details the findings, noting that Australia’s health care also bears a huge financial and health burden from safety lapses, with the resulting additional treatment accounting for 13 per cent of Australian public hospital expenditure.
Luke Slawomirski writes:
The official death toll from the SARS-CoV-2 pandemic stands at over 1 million globally — a tragic statistic. While many of these deaths could perhaps have been avoided, it must be acknowledged that most countries implemented public health policies that saved many more lives.
Our recent OECD report sheds light on another public health crisis, one that unfolds every week, every month of every year: patient harm resulting from safety lapses during health care.
The report found that, each year, unsafe care results in over 3 million deaths worldwide. The annual disease burden of adverse events is estimated at 64 million Disability-Adjusted Life Years (DALYs) – exceeding the burden of by malaria, tuberculosis and diabetes.
Patient harm also slows economic growth by over 0.76 per cent of GDP each year. Like any disease that leads to morbidity or premature death, harm impairs physical and mental function. This can mean time off work, lower productivity, and greater reliance on the welfare system.
We estimate that if adverse events were eliminated beginning in 2015, by 2024 the global economy would be about $US30 trillion larger than currently projected.
Most of the burden of safety lapses is felt in low-to middle-income countries, with recent estimates suggesting as many as 4 in 100 people die from unsafe care in the developing world.
Yet even in advanced economies boasting high-tech health systems, about 1 in 10 patients continue to experience harms such as healthcare-associated infections, blood clots, pressure ulcers, falls, medication mix-ups and diagnostic errors.
This exerts a high personal toll on patients and their loved ones. It is also financially very costly. We estimate that treating harmed patients consumes over 12 per cent of all health spending in OECD countries. Factoring in that not all harms can be prevented reduces this figure to 8.7 per cent.
About 1 in 9 Australian hospital patients are harmed during their admission, with the resulting additional treatment accounting for 13 per cent of Australian public hospital expenditure.
This should be of great importance to not just clinical staff but to management because these additional costs are greater than any additional revenue generated by keeping the patient longer, but also less than the revenue generated by admitting a new patient.
Unsafe care affects the bottom line, to the tune of about $16.5 billion each year in Australia.
It’s an eye-watering amount given that we are talking about incidents that can be can be avoided through basic measures hand hygiene and infection control, more effective communication at transitions of care, consistent use of protocols and checklists, and engaging the patient as partner in, not a passive recipient of, care.
Not only are these things simply elemental aspects of care, they are also cheap especially when measured against the cost of harm.
Systems, not individuals, are to blame
The report shows that interventions aimed at reducing healthcare infections, falls and pressure ulcers provide the best return on investment – in some cases 7-fold. Ensuring information is transferred between providers and patients effectively also pays off handsomely. Evidence for digital technology helping to reduce harms such as medication and diagnostic error is also growing.
But these interventions do not exist in a vacuum, and must be applied consistently across a highly complex, fragmented health system. This is more difficult than it sounds and may be the reason why studies show such poor compliance with established clinical norms and guidelines.
To be clear, an adverse event is rarely the fault of a single clinician, and health professionals never set out to intentionally harm their patients. Harm is typically the result of humans performing complex tasks in a system where the necessary processes and safeguards are not in place.
Investment is therefore needed to correct this across all tiers of health, especially in governance, education and skills, and, crucially, better information systems. Communicating, and getting data from across the various settings and silos must be a lot easier than it currently is.
The report makes the case for aligning clinical, corporate and professional risk. This does not necessarily mean applying financial penalties or rewards.
For example, it is uncommon for hospital CFOs to see data on patient harm in terms of revenue ‘lost’. Adding this to the usual suite of performance indicators may — just may — move safety up the list of priorities. All that is needed is information packaged in a better, more meaningful way.
In short, no healthcare provider sets out to harm their patients. But the systems they operate in are simply not organised for safety.
This is why, despite the best individual intentions, the global burden of patient harm exceeds that of COVID-19, and is in the same league as diabetes and HIV/AIDS.
Almost 10 per cent of health spending is consumed by fixing eminently avoidable errors. While the interventions to make care safer play out at the clinical coalface, they have little chance of success without system-level foundations and policies.
The bad news is that there is still a long way to go to set up health systems for safety. The good news is that doing so can reduce much human suffering and free up billions of dollars for more productive means.