| Almost 70,000
British patients a year die partly
as a result of "adverse events" they suffer during hospital
stays, says a shocking report. One in ten of all patients
admitted to hospital is harmed by complications, half caused by medical
mistakes of some kind.
The cost of the extra days in hospital needed is running to at
least 1.5 billion dollars a
year, said the research team from University College London.
A leading doctor said that the profession was failing to "learn
from its mistakes".
The study looked at more than 1,000 medical and nursing records
at two hospitals in London, then expanded these results to produce
national predictions.
Researchers found that almost 11% of patients had suffered some
sort of adverse event - some more than one.
In approximately 50%, the researchers judged that hospital staff
should have prevented them happening.
Contributing to death
A third of the events led to "moderate or greater impairment"
- in 19% of cases, the decline in their health as a result was permanent,
and in 6%, the adverse event contributed to death.
The main causes of adverse events relate to operative errors, drugs,
medical procedures and diagnosis. Each of these is amenable to
prevention.
However, he also admitted that mistakes were inevitable because
there were too few medical staff, who were forced to work too quickly
to cope with intense demand.
An earlier Australian
study estimated that adverse events accounted for 8% of hospital
bed days and cost the Australian healthcare system $4.7 billion
a year.
The researchers found that 10.8% of patients admitted to hospital
experience an adverse event, with an overall
11.7% rate of adverse events when multiple adverse events are included.
About half of these events were judged preventable. A third
of adverse events led to moderate or greater disability or death.
Some adverse events are serious and are traumatic for both staff
and patients. Others are frequent, minor events that go unnoticed
in routine clinical care and yet together have massive economic
consequences.
This study is primarily a pilot and has
certain limitations. The study was small and based on only two hospitals.
In addition, the case mix does not accurately reflect hospital
practice. The specialties included in the review could have higher
rates of adverse events than other specialties.
Although we cannot extrapolate with any precision, our findings
strongly suggest that adverse events are a serious problem
in the NHS, as they are in the United States and Australia. We estimate
that around 5% of the 8.5 million patients admitted to hospitals
in England and Wales each year experience preventable adverse events,
leading to an additional three million bed days.
About half of the adverse events were
preventable with current standards of care
British
Medical Journal March 4, 2001 517; 548; 562
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