- As many as 24,000 patients die in Canadian hospitals
each year, while tens of thousands more are crippled, injured or poisoned
in association with medical errors that could have been prevented.
- A new landmark study of 20 hospitals in five provinces
found one in 13 patients suffers an adverse event, more than double the
rate found in studies of U.S. hospitals.
- "I think this is pretty explosive data," said
Alan Forster, a health services researcher at the Ottawa Hospital Research
- "When you start looking at these numbers, you really
see the problem in a graphic way."
- The study, to be published in the Canadian Medical Association
Journal, found 185,000 patients a year suffer adverse events.
- Such events cost taxpayers billions of dollars, usually
in longer hospital stays.
- They included drug overdoses, botched diagnoses, patients
whose spines were sliced by errant scalpels and one woman whose ovaries
were removed without her consent.
- Researchers say 37% of events could have been prevented,
noting Canada lags behind the United States and other countries in confronting
- "We think there is a huge opportunity to reduce
that number," said study co-author Peter Norton, a professor of family
medicine at the University of Calgary.
- But while the study is aimed at improving safety, legal
experts fear it will open hospitals up to lawsuits, prompting them to stifle
doctors and nurses from reporting mishaps.
- "What has been happening in the States in the past
five years ... is there's a medical malpractices crisis," said John
Morris, a lawyer for Sunnybrook and Women's College Health Sciences Centre
in Toronto, which is being sued by a group of former patients.
- "They're attributing part of that to this whole
movement for patient safety and medical error recognition and disclosure."
- In recent years, hospitals have struggled to change the
"blame-and-shame" culture that traditionally has made doctors
and nurses reluctant to report mistakes and mishaps.
- "People talk about the shunning, and the 'how could
you let this happen?' sort of thing," says study co-author Ross Baker,
a professor of health policy, management and evaluation at the University
- "People are frankly afraid that they're going to
get beaten up. They're worried that they're going to get sued or that action
will be taken to discipline them in the health care organization."
- In 1999, the U.S. Institute of Medicine published its
report on medical errors, "To Err is Human," an effort to bolster
patient safety. It cited studies in Colorado and New York that found adverse
events ranged from 2.9.% to 3.7% of hospital admissions.
- By contrast, the new study found 7.5% of the 2.5 million
patients admitted to Canadian hospitals each year suffer adverse events.
Dr. Baker says the American studies were focused mainly on major events
that could attract lawsuits, not minor problems.
- When compared to similar studies in the United Kingdom,
New Zealand and Australia, Canada fared well, especially when preventable
errors were considered. For example, a study of 28 Australian hospitals
in 1992 found 51% of adverse events could have been avoided. A study of
two teaching hospitals in the U.K. found 48% were preventable. The Canadian
figure of 36.9% was virtually identical to a New Zealand study in 1998.
- "Canada pretty much falls in the middle of the pack,"
said Alan Bernstein, president of the Canadian Institutes of Health Research,
which funded the study.
- Dr. Bernstein said health care systems need to copy the
experience of the airline industry, which reduced its error rate by improving
- "We need to encourage a culture where people aren't
afraid to come forward and report problems," he said.
- In the study, researchers looked at 3,745 patient charts,
chosen at random from 20 hospitals in five provinces, including Ontario
- They found the greatest number of adverse events occurred
at teaching hospitals.
- "This is probably due to the complexity of care,"
said Dr. Baker, noting the most complicated cases are usually referred
to teaching hospitals.
- Not all adverse events are preventable. Some things,
like an allergic reaction to a drug, often cannot be anticipated. The study
found that preventable errors were about the same at small, large and teaching
- "If we think about preventable errors as a mark
of quality, then smaller hospitals do as well as teaching hospitals,"
said Dr. Norton. "I think some of our smaller hospitals have thought
of themselves as second-class citizens. This study shows it's not so. They
may do less complex procedures, but they don't commit more errors."
- The researchers found older patients were the ones most
likely to suffer an adverse event. This is because seniors tend to have
more complex illnesses, so they undergo more procedures and tests and stay
in hospital longer.
- The researchers say a move to electronic medical records
and hiring more nurses would be a good start at reducing errors.
- Dr. Norton says it would be worth the added expense,
noting each adverse event resulted in an average hospital stay of six extra
- "Multiply 70,000 preventable events by six days
in hospital," he said. "That's a lot of money. And if we can
prevent that, we're going to empty beds sooner, which improves access to
beds. Access is a huge issue for us."
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