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September 23, 2007
I have referred to adverse events in Australia's public hospitals before as well as the culture of denial that exists within the medical administration and profession. We have another example from emergency care in Victorian hospitals.
Dr Andrew Buck, of the Monash Medical Centre, alleges that the shamefully chaotic state of Melbourne's hospital emergency departments is jeopardising patient safety, compromising doctors' mental health and leaving health-care agencies exposed to negligence law suits. He is actign as a whistle blower despite a regime of open disclosure being put in place in Victoria.
In a letter to the state's top health officials — sent to Health Minister Daniel Andrews and leaked to The Sunday Age — Dr Buck, a senior emergency registrar at Southern Health, says despite Monash Medical Centre buckling under record numbers of patients during the recent flu and gastro outbreaks, no extra staff were put on to help manage the crisis. Buck says:
When I came to work on Monday night all cubicles were full and there were 14 'likely admission' patients waiting to be seen and seven 'likely discharge' patients waiting, and some of these had been waiting up to eight hours to be seen.That night, even when an elderly woman suffered a cardiac arrest and died in the emergency department, there were "no extra staff put on to cope with the workload, and there was still no communication from my superiors … about risk management or bypass procedure".It left me with a real sense of hopelessness about any chance for improvement in our working conditions. If this didn't trigger action on behalf of management what would? A death in the waiting room? Multiple deaths? I was appalled that patients' lives are being put at risk, my workload and stress levels, and risk of negligence claims are allowed to escalate unchecked purely so that the hospital can receive a funding bonus.
Dr Buck said that while he could comment only on his experiences of overcrowding and under-resourcing at Southern Health, he was "positive that this situation is being replicated" across town.
According to this Senate Report in 2000 by the Senate Community Affairs Committee there is little data on adverse events in Australia. The Report states that in 1994 the Quality in Australian Health Care Study (QAHCS) was commissioned by the then Commonwealth Department of Human Services and Health to determine the proportion of admissions associated with an adverse event (AE) in Australian hospitals. This was the first published study in Australia that attempted to identify quality of care problems in Australian hospitals and the Senate Report states that:
The QAHCS study found that 16.6 per cent of hospital admissions were associated with an adverse event and 51 per cent of the adverse events were considered preventable....While in 77.1 per cent of cases the disability had resolved within 12 months, in 13.7 per cent the disability was permanent and in 4.9 per cent the patient died. For the two categories of ‘death’ and ‘greater than 50 per cent permanent disability’, the proportion of high preventability were 70 per cent and 58 per cent respectively.
The Senate Committee considered the extent of adverse events disturbing. The implications in terms of preventable adverse outcomes and the use of health care resources are substantial, especially as the Quality in Australian Health Care study suggests that in up to half of all adverse events practical strategies may be available to prevent them.
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Gary,
it appears that patient safety is coming second to the hospital budget. So says Dr Harry Hemley, the Victorian vice-president of the AMA.