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WORLD HEALTH ORGANIZATION PATIENT SAFETY PROGRAMME THE GLOBAL BURDEN OF UNSAFE MEDICAL CARE
SEPTEMBER 2013
Dear Colleagues,
A new study published on 18 September 2013 provides early evidence that adverse events due to medical care represent a major source of morbidity and mortality globally and reinforces the important role quality and safety of care plays in global health. The study, "The Global Burden of Unsafe Medical Care: An Observational Study", published today at the BMJ Quality & Safety, describes the main results of a first-ever study commissioned by the World Health Organization (WHO) and led by Dr Ashish Jha and David Bates, patient safety scientists of the Harvard School of Public Health and the Brigham & Women’s Hospital respectively.
Adapting the methodology developed for the Burden of Disease study series, the researchers estimated disability-adjusted life years (DALYs) lost to measure morbidity and mortality due to specific adverse events. Available data were found for the following set of adverse events: (i) adverse drug events, (ii) catheter-related urinary tract infections, (iii) catheter-related blood stream infections, (iv) nosocomial pneumonia, (v) venous thrombo-embolisms, (vi) falls and (vii) decubitus (pressure) ulcers. The study estimates that there are 421 million hospitalizations in the world annually and approximately 42.7 million adverse events for the seven types described, resulting in 23 million DALYs lost per year. Approximately two-thirds of all adverse events, and the DALYs lost from them, occurred in low and middle income countries. It is clear that this is an early attempt to quantify the burden of unsafe care and more analysis is needed to understand sources of imprecision in these estimates. That said, these data show that the problem of unsafe health care is significantly greater than previously thought globally and that global health policymakers should consider how to make safe patient care an international priority.
“WHO undertook the challenge of estimating the global burden of unsafe care as an essential step to guide global actions in strengthening health systems,” Says Sir Liam Donaldson, WHO Envoy for Patient Safety. “These data are a powerful signal to strengthen the performance of healthcare and to remind policy makers and professionals alike that, to achieve improvements in global health, effective investments to measure and improve the safety of the healthcare are most needed”.
The number of DALYs lost were more than twice as high in low- and middle- income countries (15.5 million) as they were in high income countries (7.2 million). Compared to other conditions, the combination of these seven types of unsafe care alone ranks as the 20th leading cause of morbidity and mortality for the world’s population. It is unlikely that these are “new” previously undiscovered DALYs, but rather that they are captured within the injuries and deaths attributed to other conditions such as cardiovascular disease.
“This study highlights that the standards for safety and quality that patients experience within the healthcare systems across the world, and especially in low-income countries, have a direct impact on their health status and wellbeing,” says Dr Marie-Paule Kieny, WHO Assistant Director General for Health Systems Strengthening and Innovation. “It is therefore essential to set effective mechanisms to reinforce and strengthen the conditions for healthcare delivery to lead to improvements in the safety and quality of care, and therefore to achieve effective universal health coverage”.
Unsafe medical care may even lead patients to opt out of using the formal healthcare system, raising questions of appropriateness and quality of care in the informal sector. In this sense, unsafe care becomes a potentially significant barrier to access for many of the world’s poor.
This study faced significant barriers due to limitations in availability and quality of data sources, hampering the ability to effectively calculate the number of DALYs lost due to unsafe care, particularly within low and middle income countries. While further refinements of the estimates are needed, the data provided in this manuscript represent a significant contribution to the understanding of the burden of unsafe care. They also signal a new direction of scientific enquiry where further methodological developments are necessary to nurture the necessary understanding of this important field.
“This landmark study is also an appeal to the donor and scientific communities to further invest and investigate in this important area of work and to creatively develop methodologies to fill the current gaps in data availability and data quality,” says Dr Edward Kelley, Coordinator of the WHO Patient Safety Programme. “Furthermore, it also calls for policy action to strengthen information systems, of which the medical record and related data sources are essential for the needed understanding about the tall of unsafe care”. The estimates provided are conservative, hindering not only the ability to calculate their consequences, but also limiting the ability of clinical leaders and policymakers to track the potential impact of policies designed to increase the safety of healthcare as well as universal health coverage.
Given the magnitude of the effects shown in this manuscript, it is fair to suggest that to improve the health of the world’s citizens, actions are needed to not only improve access to care but also to invest substantial focus on improving the safety of the healthcare systems that people access worldwide. When patients are sick, they should not be further harmed by unsafe care.
To access the article, please visit:
http://qualitysafety.bmj.com/content/22/10/809.abstract
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