Saturday, December 12, 2009

Hospital errors - more action needed

Salma Khalik of the Straits Times picks up the thread again today on hospital errors in a report entitled "Make hospital and docs more accountable". Well done.

I had posted a comment on this previously.

The restructured hospitals have generally done well in making their systems and procedures more accountable. But not necessarily more transparent. Much of the accountability, unfortunately, appear to have been put in place only for accreditation purposes.

The vogue at the moment is to seek accreditation with the US based Joint Commission International (JCI). In this accreditation exercise, reduction of hospital errors is one of the parameters assessed. It therefore became important that the hospitals have systems in place to deal with hospital errors. Or at least have the semblance of being able to deal with errors. But do the hospitals really want to know? If they really want to know they must have in place s system not just for reporting, but one also to audit the reporting, and not just expect to randomly uncover cases of non-reporting.

What do hospitals and the MOH do with these numbers? Do they really want to know the true incidences of errors? Just because there are reporting processes in place, and we can crank out statistics of some sort, shouldn't lull us into thinking that risks of hospital errors have been adequately mitigated.

Anecdotally, I know of cases of obvious practice errors, that go unreported. Recently, a wife of a friend of mine had to be wheeled back into theatre because of an error committed during surgery. I am quite certain the incident was not reported.

Reporting systems need to be audited, and the audit findings made public. Otherwise it will remain a sham. So should it be for hospital reporting - be it for surgical errors, medication errors or nocosomial infections.


Paul Ananth said...

Actually I think that there has been quite a lot of progress in trying to understand some of the root causes for errors.

Take for example, the article in this month's SMJ. There are the striking results of an audit of unscheduled readmissions from EMD. Patients seen by "Fellows", locums, MOs and MOs on Temporary Registration had three to four times the chance of reappearing in the ED compared with those seen by advanced trainees or consultants. This was mainly because of inadequate hydration but also because of missed diagnoses including intestinal obstruction and septic shock. The authors recognised this problem and introduced a specialist on every shift to try to reduce the incidence of this. Hopefully it worked. See for the whole article

gigamole said...

Fair 'nuff. But sadly I think such audits are the exception rather than the rule for hospitals/speciality departments. I would like to think that there are much more audits than reported in academic journals, but somehow, I don't think so.

I also found it curious that the paper report data from early 2005. Somewhat dated, don't you think? Especially since the response of attaching a specialist happened in 2007. One, of course assumes this was actually in response to the audit, but if the study was done in 2009, that would not have been the case, would it? :). I wonder why they chose 2005, and why they didn't complete the audit for post 2007?