Patient Harm from Medical Misadventure

"A 1999 Institute of Medicine (IOM) report, found up to 98,000 people were dying in US hospitals each year from preventable medical errors."
"In 2016, a review from Johns Hopkins hit on an unimaginably high number. Looking at studies published since the IOM report, many of which were based only on insurance claims, these researchers concluded that 251,454 hospitalized patients died from medical errors each year."
"A recent and more rigorous study came up with a far more conservative number than either the IOM study or the Hopkins research."
"Rather than simply looking at 'medical errors', authors of this study examined all adverse events and their link to patient mortality, whether a mistake or not."
"Using data from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) between 1990 and 2016, instead of simply using insurance claims, the new study settles on a number 50 to nearly 80-fold smaller than the Hopkins review."
"Across the entire study period, the authors found 123,603 deaths in which adverse events were determined to be the underlying cause of death. And after controlling for population growth and ageing over those 26 years, they found that those rates had actually fallen by over 20 percent."
"Of all the deaths related to adverse events, the study found 8.5 percent could be attributed to misadventure, or medical errors such as accidental laceration or incorrect dosage, and 14 percent could be attributed to adverse events associated with medical management."
"This isn't to say that mistakes made by medical professionals are not a problem, or that they shouldn't be fixed. Merely that grossly exaggerating this number to the point of a crisis, where a huge number of people who are hospitalized could die from a medical mistake, is demonstrably false and dangerous."
Science Alert

"Canadians place great trust in health-care organizations and are generally satisfied with the health care they receive. In 2005, 85 per cent of Canadians who received health care were 'very' or 'somewhat satisfied' with the services they received.^" "Additionally, in a recent Canadian Institute for Health Information survey of patients accessing primary care, more than three-quarters (76 per cent) reported that the quality of the primary health care they received in the past 12 months was either 'excellent' or 'very good'."
"However, a growing body of evidence over the past decade has demonstrated that misadventures during surgical and other medical care are common around the world, and Canada is no exception." "These misadventures are tragic for individuals and costly for society, as they can result in disability, death, or prolonged hospital stays. A Canadian study estimated that about 7 per cent of adults seeking acute care in Canada experience a misadventure; from these cases, close to 60,000 are potentially preventable. The latest OECD figures show that about 150 deaths are caused by misadventures during medical care each year in Canada."
The Conference Board of Canada 

Auditor General Bonnie Lysyk released her annual report for 2019 on Wednesday, and called for immediate action to reduce the number of patients who are injured while receiving care in Ontario's hospitals each year. (Paul Chiasson/Canadian Press)

"Each year, Ontario hospitals discharge one million people. Of those, about 67,000 people were harmed during their hospital stay."
"Many [long-term care home residents] require assistance eating and drinking and rely on long-term-care home staff help to maintain their health."
"Ontario has committed to spend $3.8 billion over ten years to 2026-2027 for mental  health and addictions services, so it's important that funding is allocated appropriately to meet the needs of Ontarians."
Ontario Auditor General Bonnie Lysyk, 2019 annual report

The audit found that hospitals are currently not required to report so-called "never-events" - a medical error that should never happen, such as leaving a foreign object inside a patient - to the Ministry of Health. File/Global News

Close to 70,000 patients receive injuries while in the process of receiving care in hospitals annually in Ontario, according to the province's auditor general who called for government action to help in reducing that number. The auditor general's team audit of acute-care centres resulted in the finding that six of every one hundred patients treated then discharged from hospitals in the province received harm during the process of health care provided to them.

Hospitals have no legal requirement to report to the Ministry of Health any medical error that should never happen, called "never-events". In that category would be leaving a foreign object inside a patient after surgery. The audit team visited six of thirteen hospitals that do track "never-events", finding that 214 incidents had occurred since 2015. Hospitals failed to comply with required safety practice standards on occasion, and what's more nurses repeatedly fired for reasons of incompetence often were re-hired by other hospitals.

Credit Ontario Ministry of Health and Long-Term Care

The audit recommended that hospitals and nursing agencies should be alert to and prepared to share information such as this with one another regarding poorly-performing nurses. Disciplining doctors was found to take years and in the process deleteriously impacted a hospital's budget; potentially making hospital administrations loathe to undertake needed disciplinary action. In one instance it cost a hospital $560,000, taking several years to finalize the discipline of a doctor with "practice issues".

Two other hospitals involved in disciplinary action against the very same physician laid out $1 million for their efforts to discipline the man. As legal costs for physicians in discipline matters are paid by taxpayers since government reimburses doctors for malpractice insurance fees, the auditor general felt the outcome is that doctors are willing to draw out disciplinary cases for years since there is little personal cost to themselves.

Food and nutrition in long-term care homes was another issue the auditors found is lacking to meet quality standards, when food is given patients that includes an excess of sugar and salt, and lacking sufficient fibre content. In three of five homes inspected by the audit team, patients were served food past their best-before date. Liquid whole eggs that were three months past best-before dating, was served in one of the homes, as an example.

iStock.com/Chinnapong

And as for addiction services, the audit team found wait times for treatment, opioid-related emergency department visits and death rates all rising, regardless of increased government funding. Adequate policies and procedures are lacking, to deliver timely addiction services, to monitor service providers, or to measure and report on effectiveness, according to the report's findings.

Another point of contention is that $40 million of the province's $134 million opioid strategy is equally distributed throughout all Ontario regions, and not preferentially based on need.