Last week, the WHO marked World Patient Safety Day. At its core, healthcare is singularly motivated by a desire to improve patient health and wellbeing. It is simply remarkable, therefore, that adverse events due to unsafe care is in the top ten causes of worldwide disability and mortality
It is shocking that in economically developed nations, 1 in 10 patients is actually harmed whilst receiving inpatient care. Indeed, in OECD countries, approximately 15% of hospital expenditure is a direct consequence of adverse healthcare events.
These failings, counter-intuitively, actually result from our ongoing drive to do better with healthcare. We have more and more complex healthcare systems, delivering a massive variety of interventions. For many societies, an ageing population also presents a more complex healthcare substrate: we must deal with multiple comorbidities, growing polypharmacy, and budgetary restrictions.
As a consequence of this ever-increasing complexity, the risk of harm increases. Every year, nearly seven million surgical patients suffer from a significant complication. One million of these patients die during or shortly after surgery. Most of the world’s population will suffer a diagnostic error, of some sort, at some point in their lives. From such problems as these have emerged the discipline of patient safety; aiming to reduce errors, reduce risk, and reduce harm to patients.
A healthcare system designed and run by humans, who are of course prone to err, is always going to have frailties. Add in a high-stress environment, with often restricted resources, the risks grow. Of course, high-risk operations necessarily encompass a degree of unavoidable risk. However, the human element can be mitigated by specific systems and processes designed to minimise or even eliminate errors.
The crucial first step in this process to identify and acknowledge where mistakes have happened, and harm has occurred (or nearly occurred). As surgeons, we need to be vigilant and involved.
Skull-base fellow, Leeds General Infirmary