No health care knowledge is more important than how to prevent harm to patients. So says Sir Liam Donaldson, chair of the World Health Organisation's World Alliance for Patient Safety. He is acknowledging that medical error is a major cause of death and disability, and that action to reduce known risks to patients has been poorly co-ordinated and regrettably slow the world over. In some countries, this is beginning to change.
The WHO Collaborating Centre on Patient Safety recently announced a seven-country initiative against major threats to patient safety. Its aim is to reduce five leading patient safety hazards: patient care handover errors; wrong site, wrong procedure, wrong person surgical errors; medication errors; high-concentration drug errors; and the promotion of effective hand-hygiene practices. The premise is that about 50 per cent of adverse medical events are avoidable.
Why is Hong Kong not part of this initiative? The answer is that patient safety does not have a high enough priority here. The explanation, I believe, is that the scale and costs of the medical error problem have not been appreciated.
Reliable international studies indicate that, in any one year, about 10 per cent of the population will end up in hospital: one in 10 inpatients will fall victim to a medical error resulting in harm; and the injury will cause or contribute to death in one-tenth of these cases. In developed countries, fatalities due to medical error rank high among all causes of death (10 per cent of the total), and substantially outnumber road traffic accident deaths (4 per cent).
What about the financial costs of medical error? In Britain, the health care costs alone amount to an estimated GBP2 billion (HK$31.8 billion) out of a total National Health Service budget of GBP90 billion. Costs of medical errors in the US amount to US$38 billion compared to health care spending in the order of US$1 trillion. These estimates do not include settlements for compensation and legal fees, so the overall burden may amount to 5 per cent to 10 per cent of health spending.
These estimates can justifiably be applied to Hong Kong. With a population of some 7 million, we would predict that 700,000 patients would be hospitalised each year, with an anticipated 70,000 injuries due to medical mishaps and, consequently, 7,000 error-linked deaths. We can cross-check these figures by looking at the Hospital Authority's activity report for 2004-2005, which cited 1,125,300 hospital admissions during that year. So the above injury estimates are, if anything, likely to be conservative.