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+ Patient Safety: A Major Global Health Challenge Ashish K. Jha, MD, MPH April 8, 2019

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Page 1: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+

Patient Safety:A Major Global Health Challenge

Ashish K. Jha, MD, MPHApril 8, 2019

Page 2: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+Agenda

What is the burden caused by unsafe patient care?MortalityDisabilityDiagnostic errorsFinancial costs

What have been the patient safety victories?

How can we continue to improve patient safety?

Page 3: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+ The global burden of unsafe medical care is massive

Page 4: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+How big a problem is this?

Adverse events: likely one of the 10 leading causes of death and disability in the world

Page 5: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+Major Reports: NASEM and WHO

Page 6: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+ How do we know? Approach

Used existing list of indicators Commissioned by the World Alliance for Patient Safety

Focused on major causes of harm in hospitals Infections, medications, falls, VTE, etc.

Identified prevalence, impact from: Epidemiologic data

Comprehensive literature review

Data and reports

Applied GBD modeling approaches

Page 7: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+ Adverse events per year

134 million unsafe events annually in LMICs

As many as 1 out of every 4 hospitalizations result in injuries each year in LMICs

1 out of every 4

Page 8: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+ Safety events in LMICs

27M

14M17M

27M

316K

48M

0

10 M

20 M

30 M

40 M

50 M

60 M

UTI VTE ADE Falls VAP* Ulcers

Page 9: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+ Mortality in LMICs

2M

422K

223K

41K 63K

240K

K

200K

400K

600K

800K

1M

1M

1M

2M

2M

UTI VTE ADE Falls VAP Ulcers

Page 10: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+ Deaths from Injuries

2.6 million deaths annually due to adverse events in LMICs

That means 1 in 22 people die from adverse events in LMICs

2.6 milliondeathsannually

1 in 22

Page 11: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+ Not just a LMIC problem

Page 12: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+ Post-Op sepsis after abdominal surgery

3.673

2.6582.454 2.386 2.371 2.316 2.269 2.201 2.129

1.9891.862

1.717

1.352

0

500

1.000

1.500

2.000

2.500

3.000

3.500

4.000

Page 13: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+ Obstetric trauma in instrument deliveries

16,9

11,3 10,9

9,6

8,5

7,4 7,2 6,8 6,4

4,8 4,2 3,9 3,7 3,4 3,2

0

2

4

6

8

10

12

14

16

18

Page 14: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+ So what is the global picture?

Page 15: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+ A top cause of death and disability

64 million Disability-Adjusted Life Years (DALYs) lost from adverse events

High income18%

Upper middle income

19%

Lower middle income

25%

Low income38%

Where are these DALYs coming from?

Page 16: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+ Compared to other conditions?

67 67 6456

40

0

10

20

30

40

50

60

70

80

Road Injuries HIV/AIDS Adverse Events Malaria Tuberculosis

DA

LYs,

in m

illi

ons

Millions of DALYs annually, worldwide

Page 17: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+ Beyond harms from adverse eventsTwo neglected areas of patient safety

Page 18: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+ First neglected area of patient safety:Diagnostic Errors

Page 19: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+Diagnostic errors in healthcare: HICs

5% of clinical encounters lead to diagnostic error

Many of these are delays with large consequencesCancer diagnosesMissed myocardial infarctions, strokes

Many lead to over treatment with their own effects

Page 20: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+ Problem in LMICs is much worse

Page 21: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+ How often do we get the basics right?

Location of Study

Cases Correctly Managed

CorrectDiagnosis

Unnecessary or Harmful Medicines Given

Delhi 23% 54%

Madhya Pradesh 12% 92%

Bihar3% 100%

8% 86%

Page 22: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+

Findings in Shaanxi, China

Unnecessary or Harmful?

Correct Diagnosis?

Basic Checklist?

64%

26%

18%

Unique to India?

Page 23: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+

Findings in Tanzania

Unnecessary or Harmful?

Correct Diagnosis?

Basic Checklist?

72%

33%

39%

Unique to Asia?

Page 24: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+ Diagnostic Errors in Medicine

A major problem in high income countries

A crisis in LMICs

Needs to be a major focus of the patient safety movement

Page 25: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+ 2nd neglected dimension:Substandard Medicines

Page 26: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+

1 in 10 medicines in low and middle income countries are

falsified or substandard

Substandard and falsified medicines

Page 27: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+Substandard medications

189.182

255.115

91.548

123.454

K

50K

100K

150K

200K

250K

300K

Diagnosed, Untreated Falsified and Substandard Medications

Mortality and morbidity due to falsified and substandard-quality TB medicines

Deaths YLD

Page 28: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+Unsafe care has large financial costs

Page 29: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+ Economic Impact

Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical developed country.

As much as one dollar in seven is spent treating the effects of patient harm in acute care.

The one set of investments that might pay for themselves

one dollar in seven

The Economics of Patient Safety, OECD 2017

15% of acute care expenditure

Page 30: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+ How do we address the problem of unsafe medical care?

Page 31: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+Important areas of progress…

Page 32: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+

Shift in culture from the individual to the system

Greater focus on teamwork, collaboration

Dramatic rise in use of health ICTs Certainly in HICs LMICs beginning to make progress May leapfrog over EHRs with mHealth

Greater use of safety tools Checklists RCAs

Areas of progress

Page 33: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+

Central Line infections down >75% in the US

Medication error rates appear down about 50%

Surgical care has gotten safer Anesthesia is so much safer Post-operative infections (SSIs) down across the board Other surgical complications appear to be declining

And care has gotten better

Page 34: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+But we have a long way to go

Page 35: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+

It’s about systems, not individuals

We have to move from thinking about errors to safety

Safety has to become a top priority of the HC system

Framework: how do we think about adverse events?

Page 36: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+

Mandatory and voluntary reporting of adverse events

Engage consumers and professionals

Build an integrated culture of safety

Promoting safety through policy

Page 37: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+

Avoid reliance on memory and vigilance

Focus on user-centered design

Move towards team-based care

Involve patients in their own care

Focus on better information systems

Promoting safety on the front lines

Page 38: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+

1. Focus on learning across health systems

2. Continue to learn from other industries

3. Make safety a priority of CEOs, hospital boards

4. Turn ICT investments into safer care

5. Make safety data transparent and accessible

6. Bring patients into the effort to make care better.

The future of safety

Page 39: Patient Safety: A Major Global Health Challenge · Patient harm and adverse events in hospitals consume approximately 15% of acute care expenditure in a healthcare system of a typical

+Thank you for inviting me


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