Patient safety incidents cost health service around €190m

The Irish Patients Association said the findings provided little comfort to patients and suggest  the health service is standing still on the issue of patient safety.

An estimated 54,000 patient safety or adverse incidents occurred in Irish public hospitals in 2015 costing the health service an estimated €190m in additional costs for extended hospital stays and treatment.

That’s according to a new study published in the British Medical Journal showing that the volume of adverse incidents in hospitals "remained stable" between 2009 and 2015.

The Irish National Adverse Events (INAE) study reviewed more than 3,100 adverse incidents in 2009 and 2015 to find that 14% of all hospital admissions in 2015 involved an adverse incident compared to 12.2% in 2009.

With 390,000 hospital admissions in 2015, the study estimated that 54,000 admissions were likely to have experienced one or more adverse incidents that year.

Each adverse incident, which can relate to care and treatment, hospital-acquired infections, or accidents and falls, can result in longer lengths of stay in hospital and cost the health service on average €4,700.

The volume of incidents, the study estimates, could incur additional costs of the order of €190m per annum, excluding any costs associated with legal actions or claims.

The researchers at the Royal College of Surgeons Ireland (RCSI) also found that the volume of preventable incidents did not significantly change over the study period – 9.1% in 2009 compared to 7.4% in 2015 - although the number of preventable hospital-acquired infections fell from 33.1% in 2009 down to 22.2% in 2015.

The study, however, found that the percentage of people left with a temporary or permanent physical disability as a result of an adverse incident in a public hospital had “increased significantly” from 14.6% in 2009 to 28.2% in 2015.

Adverse incidents contributed to the death of 4% of patients whose cases were reviewed in 2015.

In one case reviewed, the researchers found that a diagnosis of ovarian cancer was missed when a patient presented with shortness of breath and was diagnosed with a clot to the lung while also expressing concern about ovarian cancer. The patient was not screened and was diagnosed with advanced ovarian cancer a year later.

In another case, a GP had made repeated requests for a patient to be urgently reviewed for abdominal symptoms and given a colonoscopy before sending the patient to an emergency department where an advanced cancer was subsequently diagnosed.

The RSCI researchers concluded that the rollout of clinical programmes and guidelines may have “positively influenced” patient safety since 2009.

The Irish Patients Association (IPA), however, said the findings provided little comfort to patients and suggest that the health service is standing still on the issue of patient safety.

IPA director Stephen McMahon said it was not good enough to know the number of adverse incidents and preventable errors but the health service must examine why errors occur and make relevant changes to reduce potential harm and improve patient safety, he said.

Mr McMahon said the Minister for Health should make an annual statement on patient safety to the Dáil given the scale of costs associated with patient safety incidents.

“Based on this study we would estimate that it is costing in the region of €240m in 2021 to look after patients injured through adverse incidents and preventable error,” he said. 

That’s of a sufficient scale that the minister of the day should be making an annual statement before the Dáil on the progress being made on patient safety.

Mr McMahon said the underreporting of adverse incidents and preventable errors, as highlighted in the study, did not support suggestions that Ireland had a high rate of medical claims or litigious culture.

“The fact that there are tens of thousands of preventable adverse events and so few claims suggests that litigation is not the first port of call,” Mr McMahon said.

“The question must be asked, are patients being advised of adverse incidents or preventable errors? We are not satisfied that the policy of open disclosure, which has yet to be embedded in legislation, is being implemented. If it was, we would expect to see far more outcry from patients,” he added.

Fellow patient advocate and IPA member, Margaret Murphy, said a number of “miserable excuses” were used as caveats for the lack of real progress on patient safety, including the recent economic collapse and an ageing population.

She warned that the challenges posed by Covid-19 should not be used as an excuse or “new whipping boy” to mask future failings on patient safety.