Patient safety in secondary care
More than thirty years ago Ivan Illich cautioned the public about medically induced harm. His monograph Medical Nemesis subjected western medicine to a considered attack on the basis of detailed statistical evidence of surgical side-effects and medicine induced illness. 1
Clinical care provided in hospitals remains fraught with risk for patients, as revealed by media headlines and published reports. The failings of the Mid-Staffordshire NHS Foundation Trust 2 and the Maidstone and Tunbridge Wells Trust 3 provide objective evidence that much must be done to make the hospital experience a safer one for patients. The risk of unanticipated harm in secondary care is signifi cant and evidence presented to the House of Commons Health Committee demonstrates that about 10 per cent of patients admitted to hospital are likely to suffer iatrogenic harm as an outcome of their stay. 4 Furthermore, prevalence rates might be even higher since documentary proof is likely to underestimate the true incidence of adverse events. 5 What is clear is that the emotional and fi nancial harm experienced in the aftermath of a patient safety incident can be enormous, with repercussions for the victim and her family, other patients, practitioners, organisations and the wider public interest. 6
Complex secondary care environments provide fertile ground for the occurrence of errors. Adverse safety incidents will occur and eliminating all human error is diffi cult, if not impossible. Data collected by the National Patient Safety Agency (NPSA) 7 as well as global evidence obtained by the World Health Organisation 8 show that iatrogenic harm in secondary care typically includes errors and delay in diagnosis, drug and treatment errors, technical faults with equipment, and hospital acquired infections. Incident rates vary between specialities but overarching themes are apparent.