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More than 1 in 20 patients will suffer some kind of harm during their care, half of which could be avoided, British researchers conclude in a systematic review highlighting advanced specialties such as surgery and intensive care as conferring the risk of cancer. higher.
Maria Panagioti, PhD, senior lecturer at the Center for Translational Research on Patient Safety at NIHR Greater Manchester, University of Manchester, reviewed data from more than 330,000 patients in 70 samples from around the world.
Harm to the patient "A serious problem"
The research, published by The bmj on July 17, showed that 12% of the patients had had harmful incidents and 6%, incidents that the researchers had considered as avoidable.
Of these, 12% were serious, resulting in permanent disability or death. Nearly half were substance abuse and treatment management incidents and almost one-quarter were surgical procedures.
The highest prevalence of preventable damage was found in surgical and intensive care units, while the lowest was recorded in obstetrics, with no difference between different regions of the world.
The team writes that the results "badert that preventable harm to patients is a serious problem in all medical care settings".
Researchers say the "priority areas" in solving the problem are "mitigating the main sources of preventable harm to patients," such as drug-related incidents and greater focus on advanced medical specialties .
"It is also imperative to gather evidence in areas such as primary care and psychiatry, vulnerable patient groups and developing countries," as well as to "improve the standards of badessment and evaluation. notification on prevention capacity ".
Main cause of morbidity and mortality
Patient damage during health care is a leading cause of morbidity and mortality, equivalent to multiple sclerosis or cervical cancer in developed countries and to tuberculosis or malaria in developing countries , say the authors.
Increasingly recognizing that certain harms, such as adverse drug reactions, can not be avoided, the focus has been more on preventable harm.
The researchers write that this could include errors or omissions by health professionals, failures in the health system, or both.
Noting that none of the systematic reviews of patient harms so far focused on preventable harm, they searched the Medline, Cinahl, Embase, Pubmed, WHOLIS, Google databases. Scholar, SIGLE and PsycINFO.
They searched for prospective, retrospective and cross-sectional studies conducted in all health care settings in all geographic areas and published since the beginning of the century.
They clbadified preventable damage by severity and those related to drugs, diagnosis, medical procedures and infections in health care facilities.
Examination of evidence
Of the 7313 initial citations, the researchers included 66 studies involving 70 independent samples, including 33 in the United States, 27 in Europe and 10 elsewhere. Fifty samples were retrospective or cross-sectional and 45 were from general hospitals.
Among these studies, a pooled sample of 337,025 patients was selected, which included a total of 47,148 adverse events, of which 25,977 (55%) were found to be preventable.
The pooled prevalence of avoidable patient damage was 6%, compared with 12% for patient injuries.
The highest prevalence of preventable harm in patients was ICU (18%) and surgery (10%), while the lowest prevalence was obstetric (2%).
Nearly half (49%) of the preventable damages in patients were mild in nature, 36% were moderate, and 12% severe or fatal.
The most common types of incidents related to medication management, in 25% of cases, followed by other incidents related to treatment management, 24%, surgical procedures at 23%, 16% health and 16% diagnosis.
Univariate badysis suggested that the prevalence of preventable damage in patients was higher in advanced specialty studies such as surgery and intensive care, in smaller samples, and in studies involving children and older adults. .
In multivariate badysis, only the health care setting remained a predictor of the prevalence of preventable harm to patients, with the risk being significantly increased in advanced hospital specialties (p <0.001).
There was no badociation between the preventable damage to a patient and the World Health Organization region in which the study had been conducted, the design of the patient, and the lack of any information. study or how avoidable damage was badessed.
"Serious Concerns" Raised
Irene Papanicolas, PhD, Department of Health Policy, London School of Economics and Political Science, and Dr. José Figueroa, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, USA, introduced study in an editorial.
They say that this "raises serious concerns about the safety of health systems".
However, they note that there is "no consensus on what constitutes avoidable harm, and even experienced clinicians vary in the extent to which they agree on whether or not an error is avoidable ".
Papanicolas and Figueroa believe that the definition used in this study has its limits, in particular the fact of relating the harm done to a patient to a specific process or standard of care, which neglects the complex interaction that characterizes injury.
In addition, they believe that many harms are "only partially preventable and that it is therefore difficult to distinguish between the inevitable and the inevitable".
They suggest that in order to better understand the preventable harm to patients, it will be necessary to capture all potential risks, not just adverse events, to improve the ability to detect harm and to involve patients and patients. the public to identify the causes of harm.
Nevertheless, Irene Papanicolas and José Figueroa say the study "recalls the prevalence of medical harm in all health systems and, more importantly, draws attention to what is potentially avoidable".
The study was funded by the UK General Medical Council. The NIHR Greater Manchester Translational Center for Patient Safety funded the time spent by the author for this project. The members of the research team were independent of the funding agencies.
No other financing or conflict of interest declared.
BMJ 2019; 366: 14185 doi: 10.1136 / bmj.l4185
BMJ 2019; 366: l4611 doi: 10.1136 / bmj.l4611
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