Around one in 20 patients are exposed to preventable harm in medical care – and one in eight of these cases are severe or led to death – even though early detection and prevention of patient harm in healthcare is an international policy priority, UK-led research* published today in The BMJ has revealed. The researchers behind the study called for mitigation of major sources of preventable patient harm such as drug incidents, for evidence to be properly recorded across specialties including primary care and psychiatry, and for better assessment and reporting standards.
The research team, from Manchester and Nottingham, designed a systematic review and meta-analysis to quantify the prevalence, severity, and nature of preventable patient harm across a range of medical settings globally – because, they pointed out, “patient harm during healthcare is a leading cause of morbidity and mortality internationally”. Their analysis included 70 observational studies, involving a total of 337,025 patients, that had reported prevalence, severity and types of preventable patient harm in medical care.
They found that the pooled prevalence for preventable patient harm was 6% – and that a pooled proportion of 12% of preventable patient harm was severe or led to death. The largest proportion of preventable patient harm was accounted for by drug-related incidents (25%) and other treatments (24%).
Compared with general hospitals, where most evidence originated, they noted that preventable patient harm was more prevalent in advanced specialties (intensive care or surgery). They added that only two studies were based in primary care, where more than 80% of health care service is delivered internationally, and no evidence was identified in psychiatry.
They concluded: “Our findings affirm that preventable patient harm is a serious problem across medical care settings. Priority areas are the mitigation of major sources of preventable patient harm (such as drug incidents) and greater focus on advanced medical specialties. It is equally imperative to build evidence across specialties such as primary care and psychiatry, vulnerable patient groups, and developing countries. Improving the assessment and reporting standards of preventability in future studies is critical for reducing patient harm in medical care settings.”
The authors of an accompanying editorial** commented that the study raises serious concerns about the extent of medical harm across health systems, and draws attention to just how much of that harm is “totally preventable”. They said: “Moving forward, efforts need to be focused on improving the ability to measure preventable harm. This includes fostering a culture that allows for more systematic capturing of near misses, identifying harm across multiple care settings and countries, and empowering patients to help ensure a safe and effective health system.”
*Panagioti M, Khan K, Keers RN, et al. Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis. BMJ 2019; 366: l4185 doi: 10.1136/bmj.l4185
**Papanicolas I, Figueroa JF. Editorial: Preventable harm: getting the measure right. BMJ 2019; 366: l4611 doi: 10.1136/bmj.l4611