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Counting the Cost

July 30, 2012

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By Alisa Kim

Most people who go to a hospital probably do not worry about patient safety. After all, we seek medical care to get better, not worse. Unfortunately, whether owing to an error, infection or other injury, some people suffer harm as a result of hospitalization. Injuries that are caused by the delivery of care and not a patient's underlying condition are considered adverse events. A 2004 study published in the Canadian Medical Association Journal indicates that in 2000, 7.5% of adults admitted to Canadian acute care hospitals had at least one injury from their medical care, and almost 37% of those events were likely preventable.

"How much money are we spending taking care of patients that have been injured by safety problems in acute care hospitals? A lot. It was roughly $400 million a year in Canada, which puts patient safety as the third or fourth most expensive hospital-related condition in Canada," says Dr. Ed Etchells, a researcher in evaluative clinical sciences at Sunnybrook Research Institute (SRI).

Etchells is the associate director of the University of Toronto Centre for Patient Safety, a joint initiative of the university, SickKids and Sunnybrook Health Sciences Centre. He and Dr. Nicole Mittmann, an associate scientist in evaluative clinical sciences at SRI, led a team of researchers looking at the cost of patient safety issues to the Canadian health care system. The results were recently published in a report titled, "The economics of patient safety in acute care." Mittmann, who is the director of the Health Outcomes and PharmacoEconomics research group at SRI, says the project "was a nice marriage of a clinical area and an economic question."

Etchells and Mittmann estimate the cost of all adverse events in Canadian hospitals between 2009 and 2010 to be just over $1 billion; this includes $397 million spent on treating preventable adverse events.

The researchers examined studies published between 2000 and 2011 on the cost of adverse events in the acute care setting. Some of the issues they focused on were adverse drug reactions, hospital-acquired infections, bed sores, fall-related injuries and objects left in patients during surgery. They found there was no costing methodology in most of the studies. Moreover, Etchells and Mittmann say the economic evaluations of patient safety improvement strategies lacked strong clinical evidence.

"It's not transparent how they came up with the numbers that they did. And unless you have evidence to show that something is effective, it can't ever be cost-effective," says Mittmann. "The takeaway is that there should be some clear guidance on how to conduct a good economic evaluation in a patient safety economic study. That involves good clinical evidence and good costing methodology, which we didn't see a lot of."

They also identified "economically dominant" patient safety improvement strategies. These improve safety and save money and should therefore be adopted universally, says Mittmann. Such strategies include consulting a pharmacist to verify a patient's medications at the time of hospital admission to prevent an adverse drug reaction, counting sponges during surgery and using a specific procedure to prevent central line-associated bloodstream infections.

Etchells says that although it is challenging to do a study that shows a safety improvement measure works well, researchers in this area need to do a better job of providing solid evidence of the effectiveness of a particular strategy. "If you're going to invest a lot of money improving safety, [then] you should invest it wisely, as you would in any other health care program. Drugs should be effective; improvement strategies should be effective."

Drs. Ed Etchells and Nicole Mittmann