Analysis of In-Hospital Adverse Events in Canada
Overview of Canada’s Healthcare System
Canada provides universal healthcare to its citizens through Medicare, a publicly funded system that ensures access to medically necessary services without out-of-pocket expenses. Despite the advantages of this system, it has its imperfections. Following the Institute of Medicine’s influential report on medical errors in the U.S., the Canadian Adverse Events Study emerged in 2000, revealing that approximately 185,000 hospital admissions were associated with adverse events, with nearly 70,000 of these being potentially preventable.
Recent Study on Hospital Harm
A recent population-based cohort study in Ontario aimed to evaluate the incidence of hospital harm using administrative health data. This study, led by the Canadian Institute of Health Information (CIHI) and the Canadian Patient Safety Institute, assessed several factors, including the impact of hospital harm on the length of hospital stays, the duration of person-centred episodes of care, and the overall costs incurred by the healthcare system. Data was sourced from the Institute for Clinical Evaluative Services (ICES) database, focusing on patients aged 18 to 105 who were admitted to the hospital between April 2015 and March 2016.
Study Methodology and Findings
Participants were required to have an acute hospital admission and subsequent care until discharge, followed by a 30-day stabilization period in the community. Admission reasons were categorized into sectors including pregnancy, trauma, mental health, cancer, renal issues, planned surgical and medical cases, as well as unplanned surgical and medical situations.
Of the over 600,000 patients eligible for the study, nearly 6% (36,004 patients) experienced some form of hospital harm. The highest incidence of harm occurred in trauma patients, whereas the lowest was noted in mental health cases. Healthcare-related conditions were identified as the primary sources of harm. The average length of stay due to hospital harm was longest for mental health cases, at 24 days, while the highest costs were associated with unplanned surgical care.
The study’s findings highlighted that the overall impact of hospital harm on the Canadian healthcare system amounted to 407,696 hospital days, 661,646 person-centred episode days, and exceeded $1 billion CAD. If the adverse events identified were prevented, the healthcare system’s burden would be significantly reduced to 271,798 hospital days, 441,097 person-centred episode days, and approximately $725 million CAD in costs.
Limitations and Future Directions
It is important to note that the definitions of hospital harm and cost attribution in this study were designed to be comprehensive, which may have led to an overestimation of the impact. Furthermore, the methodology did not encompass all harmful events, focusing only on those deemed potentially preventable. It is also acknowledged that not every instance of harm within hospitals is preventable.
The findings from this research aim to deepen the understanding of hospital harm’s impact and identify necessary preventive measures. The Canadian Patient Safety Institute has recognized that in-hospital adverse events are often linked to various clinical conditions. Therefore, broad interventions, including cultural shifts within institutions and the implementation of audit and feedback programs, may be more effective in reducing these occurrences.
References
Canada, H. (2016, August 22). Government of Canada. Retrieved from https://www.canada.ca/en/health-canada/services/canada-health-care-system.html
Lapointe-Shaw, L., & Bell, C. M. (2019). Measuring the cost of adverse events in hospital. Canadian Medical Association Journal, 191(32). doi:10.1503/cmaj.190912
Tessier, L., Guilcher, S. J., Bai, Y. Q., Ng, R., & Wodchis, W. P. (2019). The impact of hospital harm on length of stay, costs of care and length of person-centred episodes of care: A retrospective cohort study. Canadian Medical Association Journal, 191(32). doi:10.1503/cmaj.181621