Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis

I would argue that the neuronal cascade of death is preventable. Thus 10 million yearly stroke survivors  are harmed by this. The status quo has nothing to prevent that harm but LEADERS change the status quo. WHOM THE HELL ARE OUR STROKE LEADERS?

Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4185 (Published 17 July 2019) Cite this as: BMJ 2019;366:l4185

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Preventable harm: getting the measure right

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1. Maria Panagioti, senior lecturer1,  
2. Kanza Khan, PhD candidate1,  
3. Richard N Keers, lecturer2,  
4. Aseel Abuzour, postdoctoral research associate2,  
5. Denham Phipps, lecturer2,  
6. Evangelos Kontopantelis, professor1,  
7. Peter Bower, professor1,  
8. Stephen Campbell, chair1,  
9. Razaan Haneef, foundation year 2 doctor3,  
10. Anthony J Avery, dean4,  
11. Darren M Ashcroft, professor1

Author affiliations

1. Correspondence to: M Panagioti maria.panagioti@manchester.ac.uk

• Accepted 30 May 2019

Abstract

Objective To systematically quantify the prevalence, severity, and nature of preventable patient harm across a range of medical settings globally.

Design Systematic review and meta-analysis.

Data sources Medline, PubMed, PsycINFO, Cinahl and Embase, WHOLIS, Google Scholar, and SIGLE from January 2000 to January 2019. The reference lists of eligible studies and other relevant systematic reviews were also searched.

Review methods Observational studies reporting preventable patient harm in medical care. The core outcomes were the prevalence, severity, and types of preventable patient harm reported as percentages and their 95% confidence intervals. Data extraction and critical appraisal were undertaken by two reviewers working independently. Random effects meta-analysis was employed followed by univariable and multivariable meta regression. Heterogeneity was quantified by using the I² statistic, and publication bias was evaluated.

Results Of the 7313 records identified, 70 studies involving 337 025 patients were included in the meta-analysis. The pooled prevalence for preventable patient harm was 6% (95% confidence interval 5% to 7%). A pooled proportion of 12% (9% to 15%) of preventable patient harm was severe or led to death. Incidents related to drugs (25%, 95% confidence interval 16% to 34%) and other treatments (24%, 21% to 30%) accounted for the largest proportion of preventable patient harm. Compared with general hospitals (where most evidence originated), preventable patient harm was more prevalent in advanced specialties (intensive care or surgery; regression coefficient b=0.07, 95% confidence interval 0.04 to 0.10).

Conclusions Around one in 20 patients are exposed to preventable harm in medical care. Although a focus on preventable patient harm has been encouraged by the international patient safety policy agenda, there are limited quality improvement practices specifically targeting incidents of preventable patient harm rather than overall patient harm (preventable and non-preventable). Developing and implementing evidence-based mitigation strategies specifically targeting preventable patient harm could lead to major service quality improvements in medical care which could also be more cost effective.

A new public health crisis: Preventable harm in healthcare

Preventable harm in stroke is simple to understand but difficult to get stroke medical leaders to acknowledge or solve. Stopping the 5 causes of the neuronal cascade of death in the first week.
 http://www.fiercehealthcare.com/healthcare/a-new-public-health-crisis-preventable-harm-healthcare?

Preventable harm in healthcare is now a public health crisis and requires a nationwide, coordinated response, said a leading patient safety organization.
Indeed, studies point to medical errors as a leading cause of death in the United States, and the National Patient Safety Foundation Monday issued a “call to action” (PDF) for a coordinated public health response to take steps to prevent avoidable errors.
“Too often, efforts to blame individuals and organizations for preventable harm diverts attention and resources away from a more effective and sustainable collective response,” the organization announced on Monday, the first day of patient safety awareness week.
The NPSF said greater collaboration and a nationwide adoption of a public health framework will help guide efforts to prevent healthcare harm. This type of approach has already helped reduce healthcare-associated infections, the organization said.

Despite localized efforts to improve patient safety, the scare of improvement has been limited and inconsistent, according to the NPSF. Some healthcare organizations have successfully implemented improving strategies, such as
using checklists, medication barcoding, revamped care transitions), but others haven’t yet been able to introduce the interventions or replicate the results.
Instead of finger-pointing and blame, the agency urges more collaboration and a coordinated, system-wide effort geared at providing safe care delivery across the continuum of care. This will require the support of healthcare workers, patient and families.
The call to action urges:

• The creation of a national steering committee patient safety to set national patient harm reduction goals and establish a nationwide action plan.
• The establishment of a centralized and coordinated national oversight of patient safety.
• Partnership with patients and families by engaging them in their care.
• Creation of national patient safety benchmarks to effective measure and monitor progress, and eliminate invalid measures.
• Identification of the causes of harm and interventions that work. This will require funding for research on preventing healthcare harm and the creation of a Health IT Safety Center that optimizes technology and minimizes unintended consequences.
• Expansion of resources to support the healthcare workforce, including initiatives to improve working conditions and establishment of communication, apology and resolution programs.