Danger zone
No health care knowledge is more important than how to prevent harm to patients. So says Sir Liam Donaldson, chair of the World Health Organisation's World Alliance for Patient Safety. He is acknowledging that medical error is a major cause of death and disability, and that action to reduce known risks to patients has been poorly co-ordinated and regrettably slow the world over. In some countries, this is beginning to change.
The WHO Collaborating Centre on Patient Safety recently announced a seven-country initiative against major threats to patient safety. Its aim is to reduce five leading patient safety hazards: patient care handover errors; wrong site, wrong procedure, wrong person surgical errors; medication errors; high-concentration drug errors; and the promotion of effective hand-hygiene practices. The premise is that about 50 per cent of adverse medical events are avoidable.
Why is Hong Kong not part of this initiative? The answer is that patient safety does not have a high enough priority here. The explanation, I believe, is that the scale and costs of the medical error problem have not been appreciated.
Reliable international studies indicate that, in any one year, about 10 per cent of the population will end up in hospital: one in 10 inpatients will fall victim to a medical error resulting in harm; and the injury will cause or contribute to death in one-tenth of these cases. In developed countries, fatalities due to medical error rank high among all causes of death (10 per cent of the total), and substantially outnumber road traffic accident deaths (4 per cent).
What about the financial costs of medical error? In Britain, the health care costs alone amount to an estimated GBP2 billion (HK$31.8 billion) out of a total National Health Service budget of GBP90 billion. Costs of medical errors in the US amount to US$38 billion compared to health care spending in the order of US$1 trillion. These estimates do not include settlements for compensation and legal fees, so the overall burden may amount to 5 per cent to 10 per cent of health spending.
These estimates can justifiably be applied to Hong Kong. With a population of some 7 million, we would predict that 700,000 patients would be hospitalised each year, with an anticipated 70,000 injuries due to medical mishaps and, consequently, 7,000 error-linked deaths. We can cross-check these figures by looking at the Hospital Authority's activity report for 2004-2005, which cited 1,125,300 hospital admissions during that year. So the above injury estimates are, if anything, likely to be conservative.
There is no reliable data on the incidence of hospital injury in Hong Kong, but we know the figures outnumber those for traffic accidents. Police documented 18,873 such accidents last year, of which 144 were fatal and 2,508 were serious.
Mortality data is also instructive. The crude death rate in Hong Kong is 5.6 deaths per 1,000 people, so some 39,000 people die each year. If, as in other modern societies, medical mishaps contribute in some way to 10 per cent of these, then the figure is around 3,900 error-linked deaths per year. However you do the maths, the result is the same: a substantial death and injury toll linked to medical error.
The Hospital Authority's current budget is HK$27 billion; a conservative, 3 per cent estimate of the cost of medical errors would be almost HK$1 billion annually.
Safety in health care is too important to be left to governments, hospital managers and health care professionals. Patients and the public are major stakeholders and have a right to be involved. Hospital error pathways need to be detected and corrected by a mechanism that ensures lessons learned in one setting can be disseminated widely to prevent avoidable harm from recurring in other locations.
As other countries have learned, this task is best achieved by an independent patient safety agency that co-ordinates safety initiatives and ensures quality control of remedial actions. The public should urge the government to act to improve the climate of hospital safety in Hong Kong by: adequately assessing the scale of the hospital medical-error problem; establishing a patient safety agency; and joining the World Alliance for Patient Safety. After all, why wouldn't you want a safer, more cost-effective health care system?
Darren Mann is a clinical associate professor (honorary) at the Chinese University of Hong Kong and examiner in surgery of the Royal College of Surgeons of Edinburgh
