Patient safety remains one of the most pressing health issues for public education and further policy action. Over 15% of hospital expenditure and activity in OECD countries can be attributed to treating patients who experience a safety event, many of which are preventable (Slawomirski, Auraaen and Klazinga, 2018[1]). The World Health Assembly recently endorsed the establishment of an annual World Patient Safety Day to further strengthen awareness and galvanise concerted action for safer care.
Patient safety problems may be categorised as “sentinel” or “never” events: events that should never or very rarely occur; and “adverse” events: events that cannot be fully avoided, but whose incidence could be considerably reduced.
Figure 6.4 illustrates rates for a never event – a foreign body left in during a procedure – using both linked and unlinked data (see the “Definition and comparability” box). The most common risk factors for this never event are emergencies, unplanned changes in procedure, patient obesity and changes in the surgical team. Preventive measures include checklists, counting instruments, methodical wound exploration and effective communication among the surgical team.
Figure 6.5 illustrates rates for an adverse event – the percentage of hospital inpatients with health care-associated infections (HAIs) – in OECD countries, together with the proportion of bacteria causing these infections that are resistanct to antibiotics. HAIs are the single most deadly and costly adverse event, representing up to 6% of public hospital budgets (Slawomirski, Auraaen and Klazinga, 2018[1]). This impact is increased by antibiotic-resistant bacteria, which can make HAIs difficult or even impossible to treat.
On average, across OECD countries, just under 4.9% of hospital patients had an HAI in 2015-17. This proportion was 5.2% in 2011-12. The observed proportion of patients was lowest in Lithuania, Latvia and Germany (around 3%) and highest in Portugal, Greece and Iceland (more than 7%). Antibiotic resistance rates ranged from 0% in Iceland to nearly 70% in Latvia, although these rates should be interpreted with caution due to small sample sizes in some cases.
Figure 6.6 shows rates for two related adverse events – pulmonary embolism (PE) and deep vein thrombosis (DVT) after hip or knee replacement surgery – using both unlinked and linked data definitions (see the “Definition and comparability” box). PE and DVT cause unnecessary pain and in some cases death, but they can be prevented by anticoagulants and other measures. The large variations observed, including an over 25-fold variation in DVT rates, may be explained in part by differences in diagnostic practices across countries.
