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reducing patient harm in hospitals: how getting to zero harm is not one-size-fits-all
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according to the report on hospital harm, those who experience harm will have to stay in the hospital five times longer than those who don’t, with an average stay of 28 days versus six.
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according to the new hospital harm project by the canadian institute for health information in collaboration with health excellence canada, 1 in 17 patients experience at least one harmful event that could have been avoided while in acute care at hospitals across the country.
dr. praby singh, an ent surgeon and medical director for the scarborough health network (shn), notes that the report is important because it presents the data, allowing hospitals to see what needs to change.
“for us, harm is very important. our population group is sensitive. we have a very mixed multicultural population, a lot of people who don’t have english as their first language,” he said. “when we see harm for our group of patients in hospital in scarborough, our focus is on how we can improve that.”
the costs of hospital harm
when people go to the hospital for care, mistakes can happen, even when medical providers are doing their best to ensure they don’t. when it comes to hospital-acquired harm, the top reasons people may experience harm include infections, pneumonia, aspiration pneumonitis, electrolyte and fluid imbalance and delirium.
that said, those fall under the umbrella of the top of the list. there are more ways for someone to experience harm, says dr. singh, such as “troubles with medications, troubles after surgery, delays of treatment.”
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of the 1 in 17 who experience a harmful event, about 25 per cent will be involved in multiple events, which leads to longer hospital stays. according to the report, those who experience harm will have to stay in the hospital five times longer than those who don’t, with an average stay of 28 days versus six.
these effects aren’t just harmful for the patients. they are also costly, taking the average $9,792 cost of a hospital stay and quadrupling it to $44,641.
addressing the issue isn’t one-size-fits-all
while the report shows an issue, some hospitals are doing better than others. however, it’s not easy to deduce what needs to be done because every hospital is different, and thus may have shortcomings in different areas.
dr. singh notes that it’s hard to comment on what the causes of hospital harm are at other hospitals because of that fact.
“i don’t think one-size-fits-all would work in a place like canada, where we have different population groups and different stresses and all the provinces are different in how they approach health care,” he said.
for shn, their approach to ensuring they provide the best possible care and reduce harm is simple.
“our approach has been to identify what is causing the harm underlying and then to target those reasons,” said dr. singh. “you would have to do that in any scenario where you need to understand the problem.”
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for example, if the hospital is in a diverse area they will have to consider language differences and adjust their care accordingly. this is so that people who don’t speak english or are new to the language have access to interpreters to ensure they can adequately understand and share their health concerns.
“it’s understanding our population and how we can treat them better,” said dr. singh.
scarborough health network leading the way
currently, shn holds a top spot amongst four other hospital networks across the country when it comes to patient care, with one location being an “extreme excellence outlier,” making it one of the health care system branches that has been able to reduce harm by looking at what’s missing for their patients and implementing change as best as possible.
they offer strong interpretation services and introduce new tech that makes it easier for patients and medical providers to be 2022年世界杯预选赛比分表re. this has worked for them because at the cornerstone, patients are the top priority.
“we want to make sure that if a patient can’t advocate for themselves, we help with that advocacy,” said dr. singh. “we have a strong family network of our patients in the hospital, so we highly encourage them to be part of the conversation when it comes to treatment and care.”
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this patient-first approach sits at the top of what’s worked for scarborough hospital network, and issues that fall across the board could all be improved by simply putting the patient at the forefront.
“quality and patient safety is a pillar of our strategic plan at shn. these harm rates that we’re seeing at shn, they’re not by chance. they’re purposeful, right?” said dr. singh. “these are purposeful decisions the organization has made.”
dr. singh and the shn network of medical professionals believe in “zero harm” targets and are doing everything they can to ensure they address issues that lead to patient harm.
other hospital systems, all of which receive their own standard reports on hospital harm, have their own work to do to reduce these events, but that can only be done through a highly personalized lens, and everyone in the system has to be on board.
“we dive deep into our problems and figure out what the root causes are,” said dr. singh. “from senior leadership all the way down to our frontline staff, commitment to improvement (is crucial) … we want to move toward all patients in our system having zero harm, and that’s our journey that we go through here at shn, so tracking misinformation and enacting on the issues is how we’re going to get there.”
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