Inadequate training or supervision of clinical staff and the absence of, or failure to follow clinical protocols were more important than a shortage of equipment or staff as causing harm to hospitalised patients in the developing world, claims a study published on bmj.com
The researchers estimate that on average, these failures account for more than one death per day in each hospital studied, the vast majority of which are preventable.
The authors from the New York City Health and Hospital Corporation of the study initiated by the World Health Organization, looked at patients from 25 hospitals altogether across eight countries: Egypt, Jordan, Kenya, Morocco, Tunisia, Sudan, South Africa and Yemen. The study found that harm to patients that was caused by their health care rather than their disease is a major public health problem and consistent with previous reports from the developed world. In addition, patients in this study were more likely to die from the adverse event, than in previous developed world reports.
The study aimed to assess the frequency and nature of adverse events in these hospitals. An adverse event was defined as an unintended injury which resulted in temporary or permanent disability or death and which was associated with healthcare management rather than the underlying disease. Objectives included assessing the frequency, cause and preventability of an adverse event.
Data was collected during 2007. In total, events were recorded for just under 5,500 in-patients from all acute hospital departments. Results show that 8.2% of these patients were involved in at least one adverse event, with 83% of these events judged to be preventable. In total, 30% of events were associated with patient death. The authors found that the adverse event rate increased with both patient age and length of hospital stay.
Results show that the majority of these events were contributed to by inadequate training and supervision of staff or the failure to follow hospital policies or protocols. These factors were deemed more significant than a shortage of staff or equipment.
These figures also conclude that adverse events are the fifth most common death after COPD, digestive disease, infectious disease and cancer in at least one of these countries.
The authors conclude that the results of this study place patient safety as one of the major concerns for health in these developing countries. They argue that more confirmatory studies are required to further elucidate the underlying causes in order to identify and implement solutions and that basic clinical processes of diagnosis and treatment need broad attention.