Hospitals in developed countries are accidentally killing hundreds of thousands of patients every year, a world-leading patient safety expert says.
Peter Pronovost, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine in the US, says healthcare errors are claiming about 400,000 American lives every year – the equivalent of two jumbo jets every day.
Common errors include misdiagnoses, medication mistakes, infections due to poor hand hygiene, pressure ulcers from neglectful nursing and miscommunications in teams that lead to catastrophic oversights.
While many advances have improved safety over the past decade, Dr Pronovost said one of the biggest problems in hospitals today was an ever-increasing number of devices that do not talk to each other and distract health professionals from their most important tasks. This trend has occurred at the same time as budget cuts that have caused staff to work under maximum pressure with limited resources.
“Caregivers are fatigued by frequent alerts, many of which are false alarms from instrumentation and bedside systems that lack the most basic safety features,” he wrote in a report for the World Innovation Summit for Health launched in Qatar this week.
“For example, infusion pumps can deliver potentially lethal medication, yet healthcare still relies on manual double checks. Checklists have helped improve use of evidence-based practices, yet they have focused on a single harm, and patients are at risk of a dozen harms.”
Unlike in other industries, where many different companies’ products speak to each other while performing highly complex tasks, Dr Pronovost said the investment of trillions of dollars into healthcare technology had failed to improve productivity. Some of this could be attributed to companies not agreeing to share data and the buyers of health systems failing to insist that manufacturers collaborate.
This problem, Dr Pronovost said, was akin toplanes being built but landing gear manufacturers refusing to share information about their gears with pilots.
It was like saying, ‘Oh that’s OK, it’s your data, it’s your widget, it will be really expensive and planes will crash, people will die, but if you don’t want to share your data, that’s OK’,” he told Fairfax Media.
“That’s the way we buy technology. We’re not buying smart. We don’t have hard-headed engineers saying, ‘No way, this is what we need’ … regulators could change that overnight.”
Dr Pronovost said he was working on getting people’s electronic medical records to communicate with infusion pumps that deliver medicines in hospitals to alert staff to problems, rather than having nurses perform manual checks.
“Just for pain medicine alone, that one connection is worth $8 billion of nursing time a year in the US. There are scores of things like that where we could radically improve safety and productivity if we begin to design these systems to serve the needs of patients and clinicians,” he said.
Lord Darzi, the executive chairman of the World Innovation Summit for Health, said that with estimates up to one in 10 patients are harmed by healthcare in developed countries, patient safety should be a major policy issue for governments.
“The work undertaken by Dr Pronovost and his team on behalf of WISH provides solid evidence and new perspectives that will support the efforts of policymakers trying to improve their healthcare systems’ safety record and patient experience,” he said.
Dr Pronovost, a critical care physician, said while regulators and health leaders needed to start taking patient safety more seriously, patients and clinicians could play their own role in prevention.
He said health professionals should be taught to speak in clear, direct language to reduce miscommunication, and patients should be encouraged to ask more questions about their care.
For example, he said to prevent infections, patients should always ask if their health professional has washed their hands before they touch them. Patients with catheters should also regularly ask if they still require one, because the longer a catheter remains, the higher their chance of an adverse outcome.
“We need to encourage patients that it’s OK to speak up and not only is it OK, but your outcomes will be better and it’s safer if you do,” he said.
An Australian study published in 2011 showed that many adverse events and catastrophic errors were not being reported to authorities so health professionals could learn from their mistakes.