Monday, April 25, 2011

Different countries, same problem

A recent study* reported in Medscape Today summarized the likely factors leading to medical, medication and laboratory errors in eight countries -- Australia, Canada, France, Germany, the Netherlands, New Zealand, the UK and the USA. What is striking is the commonality across jurisdictions, irrespective of the type of health care organizational structure, including this conclusion: "Greater understanding by patients of the risks associated with health care could help to engage patients in participating in error-prevention strategies." Here are some excerpts from the discussion portion of the article.

This study found . . . a number of statistically significant relationships between experiencing an error and a patient's age, education level, presence of chronic conditions, prescription drug use, number of doctors seen, poor provider communication, poor care coordination and ED use. Overall, the three risk factors with the largest ORs** in the final regression model were (i) experiencing a care coordination problem, (ii) having seen four or more doctors within the last 2 years and (iii) having used the ED in the last 2 years. All three of these risk factors suggest issues with coordination, continuity of care and provider knowledge of the patient.

Experiencing a coordination problem had the largest OR of all the explanatory variables. This is consistent with literature that suggests that gaps in the continuity of care can create opportunities for errors to occur, and that hand-offs between health care professionals are an important element in ensuring greater patient safety.

Furthermore, gaps in coordination are an aspect of patient safety that is often very apparent to patients when they occur. Educating patients and increasing their degree of involvement in treatment plans may help to reduce the likelihood of errors occurring by empowering patients to speak up and ask questions about why certain tests are ordered and how they relate to their diagnosis.

* Andrea Scobie, "Self-reported Medical, Medication and Laboratory Error in Eight Countries," International Journal for Quality in Health Care. 2011;23(2):182-186.
** The odds ratio (OR) for each explanatory variable was calculated to determine the relative risk of experiencing an error given each hypothesized risk factor.


nasov said...

The electronic record is so important - but if the problem is apparent to the patient, I don't get why they don't report information. We don't really know that answer, do we? Empirically, I mean? We all say we have to empower them and I agree with that -- but in this case the patients sound kind of incapable. What does the doctor do then?

Anonymous said...

There are many documented factors that suppress patient engagement, including: 1) the highly vulnerable circumstances of their dependency on provider beneficence, 2) common disempowering provider communication tactics, including didactic and condescending styles that value provider over patient knowledge 3) poor public and private health education on all fronts, 4) lack of transparency in the process of care, and 5) poor use of patient complaint information as an improvement resource (e.g. first-order problem solving to avert a lawsuit), among others.

The heightened call for patients to pay attention to their care is futile if not met by changes in interaction by providers. After all, they are the information resource holders.

What if providers explain when patients come in the door: 'Errors and harm happen in hospitals, more frequently than we like. But we are working hard to do something about them. We'll go over your plan of care together, and the nurse will ask you to check the medication labels, and you'll tell me if I forgot to wash my hands. If ever you feel uncomfortable about what you think might be a safety issue, please speak up. It is the only way we can learn to do better." And then we ask them how their care was before they leave the building.

Hmm..could this ever happen in healthcare?