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The harm to hospitalized patients cost Ontarians more than $1B a year: study

When doctors and hospitals make mistakes, it harms patients. But they aren’t the only ones to pay a steep price.

A study published earlier today in the Canadian Medical Association Journal tallies the dollar cost to taxpayers — and that cost can be steep.

That’s what lead researcher Lauren Tessier and colleagues found out. Tessier is a PhD student at the Institute of Health Policy, Management and Evaluation at the University of Toronto.

Tessier and her team studied the records of 610,979 patients admitted to Ontario hospitals over a one-year period ending in March 2016. Overall, 36,004 or six per cent of the patients were harmed during their hospital stay.

The patients who suffered harm took longer to recover, spent more time in hospital, and required more healthcare to undo or mitigate the harm.

As part of the study, the researchers categorized the kinds of harms experienced by patients. Of the more than 36,000 patients who were harmed in hospital, just over half (18,027 or 50.1 per cent) suffered harm due improper treatment. That includes failing to make the correct diagnosis or making an incorrect diagnosis that led to incorrect treatment.

This category also included harm caused by medications. Such patients might have been harmed by being given the wrong drug, the correct drug but at the wrong dosage, or if they were given a drug that interacted in a dangerous way with their other medications. Patients given a medication to which they were known to be allergic would also fall under this category.

The second biggest category (13,328 or 37 per cent) was harm caused by an infection acquired during the hospital stay. The third leading cause (9819 or 27.3 per cent) was harm caused by a procedure, and the fourth (967 or 2.7 per cent) was harm brought on by accidents such as falling off a hospital stretcher.

Each of these items added to the cost of care per patient.

At the low end, women who suffered harm after being admitted to hospital during pregnancy incurred an average added cost of $800. When the harm required the patient to have an unscheduled operation, the cost shot up to $51,067.

In total, the annual cost to the taxpayer was nearly $1.1 billion.

The overall six per cent (5.9 per cent) incidence rate of harm to patients was similar to the national incidence rate of 5.6 per cent reported in 2016 by the Canadian Institute for Health Information (CIHI) and a rate of 7.4 per cent in a study in 2004.

Reported rates ‘tip of the iceberg’

The current study is one of the first to use a new method that enables researchers to capture all of the care the patient received during their stay in hospital and following discharge from hospital, including home care.

In a commentary published alongside the study, Dr. Lauren Lapointe-Shaw and Dr. Chaim Bell wrote that reported rates of adverse events are widely considered to be the proverbial “tip of the iceberg.”

As a frontline ER physician, I have no doubt that some patients are harmed during hospital admissions. Patients are living long enough to require complex medical care. The more complex the system, the greater the opportunity for errors.

However, as noted in the commentary, there are grey areas. The 2016 CIHI report listed several causes of adverse events affecting patients.

Take urinary infections for example. Sometimes, the infection is caused by a catheter that should not have been put in or was left in too long. Those are errors.

Other times, however, a urine infection happens naturally, not due to a mistake. It’s hard for experts to tell the difference.

No simple solutions

I see a lot of patients who are reappear in the ER days or even hours after being discharged from hospital. Some return visits are caused by mistakes and some are not.

The people who run the healthcare system struggle with ways to make things safer. There is a tendency among healthcare leaders to name and shame physicians and hospitals where errors take place. I believe that inhibits healthcare professionals from reporting mistakes.

The airline industry allows pilots and others to confidentially report incidents ranging from severe turbulence to near-misses in the interest of improving air safety. There is evidence that the increase in reporting errors without ascribing blame makes aviation safer.

“We certainly would not get the transparency and type of data without the anonymity,” Peggy Gilligan, the U.S. Federal Aviation Administration’s associate administrator of aviation safety, told The Atlantic in 2016.

Perhaps the medical industry should give that a try.

The CMAJ study puts a dollar cost on hospital harms. That could lead the provinces to recoup the cost from hospitals.

But in their commentary, Lapointe-Shaw and Bell cited evidence that penalizing hospitals financially might prove counterproductive. For instance, such a move might discourage hospitals from providing care to complex patients.

This new source of data clearly presents a disturbing picture. What to do with the data is not so obvious.

Note: the headline and summary have been changed to more accurately reflect the study.

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