Team poised to take lead in patient safety: A group of Ottawa physician-researchers is aiming to make health care less harmful to patients' health

January 3, 2006

By Joanne Laucius
The Ottawa Citizen

Hospital safety may not be the sexiest subject in health care. But a stream of eye-popping statistics has attracted public attention to the fact that a visit to the hospital can be dangerous to your health.

Recently, the Canadian Adverse Events Study concluded that 7.5 per cent of all hospitalizations resulted in complications or "adverse events" as doctors call them -- and one out of six of these patients died.

The Canadian Institutes of Health Research had estimated that as many as 10,000 Canadians died each year as a result of adverse events.

Last year in the U.S., the Institute of Healthcare Improvement launched its "100K Lives" campaign.

The campaign name is a reference to a 1999 Institute of Medicine report that concluded 98,000 Americans die each year from medical errors. So far, 3,000 hospitals in the U.S. have signed on.

The campaign received attention last month when Newsweek published an essay by the institute's president and CEO, Dr. Donald Berwick, who began by describing his need for a knee replacement.

"Here's the problem. Instead of helping me, health care might kill me," wrote Dr. Berwick,

a professor of pediatrics and health care policy at Harvard Medical School, who went on to describe six things hospitals can do to prevent adverse events.

In Canada, the Ottawa Hospital is poised to be one of the leaders in the new field of patient safety.

Hospital president and CEO Dr. Jack Kitts wanted patient safety to be a focus at the hospital. To do it, the hospital needed to build up a critical mass of physician-researchers, said Dr. Alan Forster, an internal medicine specialist and a member of the Ottawa Hospital Centre for Patient Safety.

The researchers now include Dr. Kaveh Shojania, who came to Ottawa in June 2004, Dr. Carl van Walraven and Dr. Lisa Calder, who is doing a master's degree in epidemiology in how to improve patient safety in the emergency room. The team calls on other researchers in areas as diverse as statistics and sociology.

While other issues, such as access to surgery, have been more prominent, the medical community agrees patient safety needs to be addressed, said Dr. Forster.

A few figures from a study led by Dr. Forster and published in 2004 help put the issue into perspective.

The study, the first major one of its kind in Canada, reviewed the charts of 502 patients chosen at random and concluded that one out of eight patients suffered some sort of adverse event. The study also tried to determine whether the adverse events were preventable.

Three patients in the study died, although none of their deaths was preventable. Five cases that resulted in a permanent disability were judged as likely preventable, including one patient who required a limb amputation after a delay in diagnosis and transfer from a community hospital. The researchers found another 19 likely preventable errors resulting in temporary disability.

One-third of adverse events are believed to be preventable, said Dr. Forster. The big three safety problems are surgical complications, hospital-acquired infections and medication-related errors. One of the problems is that the medical conditions that lead to safety problems are severe and difficult to treat, he said.

The researchers are looking, for example, at how patients are discharged from the hospital. They are also studying low-cost ways to monitor patients when they go home, including an interactive automated voice phone system that calls patients and asks simple questions.

If any of the patient's responses is flagged as being of concern, the system e-mails a nurse, who does a followup call with the patient. A system like this doesn't have to cost a lot of money, but it can prevent patient suffering and save a great deal of money by catching problems before they become severe.

"When patients don't get close followup, there can be problems," said Dr. Forster.

The patient safety centre is also involved in research with other hospitals in other cities. The centre just received a grant to look at ways to measure patient safety in five hospitals.

"One of my goals is to produce research that is transferable to any hospital," said Dr. Forster.

But finding the origin of problems and tracing them

to the outcome of an illness is not simple. Researchers must review patient charts to determine whether the patient would have been healthier if the adverse event had not occurred. It all comes down to a judgment call by a medical expert.

Little research has been done in this area -- Dr. Forster and fellow researchers know of only one study that asked reviewers to estimate the probability that the patient would have lived longer if the adverse event had not occurred. The reviewers concluded that only six per cent of the patients who died would have been expected to live an additional three months if the problems had not occurred.

"People have life-threatening problems when they come to hospitals," he said. "Bad outcomes happen because patients are sick."

The 100K Lives campaign has focused on six safety problems, including stopping surgical infections, a major cause of

complications and deaths after

operations. In his essay, Dr. Berwick said by adopting a series of simple preventative measures, Mercy Health Center in Oklahoma City operated on 1,200 consecutive patients last year without a single wound infection. The measures included giving the right antibiotics at the right time during surgery, enforcing strict hand-washing and clipping hair instead of shaving the surgery site, which prevents nicks to the skin.

But in a commentary published in October in the Canadian Medical Association Journal, Dr. Forster and his colleagues, Dr. Shojania and Dr. van Walraven, point out that while some of the 100K Lives interventions, such as ASA for patients after a heart attack, are supported by research, other interventions are not.

This includes implementing a rapid-response team to rush to the bedsides of patients with dangerously abnormal vital signs.

The teams sound like a good idea, but the only well-designed clinical trial to evaluate them found that the teams had no effect on outcomes, reported the University of Ottawa researchers.

"For every complex problem, there is a solution that is simple, neat, and wrong," the researchers said, quoting Henry Louis Mencken.

Note: Reprinted with permission from the Ottawa Citizen.