It is widely said in the patient safety community that unsafe care causes 3 million deaths per year.
It is separately estimated (Kruk et al 2018) that poor-quality care leads to 5 million deaths per year. We have shown that this is an underestimate because it only includes care in facilities. It does not include care in the home or community, which we know to be a strong determinant of avoidable death.
If we accept that poor quality care that leads to death must by definition be unsafe, then the actual deaths due to unsafe care are likely to be at least 5 million rather than 2 million.
Unsafe care can lead to death or to minor or major harm. Often it will lead to no substantial harm and will be completely invisible - a matter of luck for the healthcare provider and, especially, the patient.
We have also learned that 'Around 1 in every 10 patients is harmed in health care and more than 3 million deaths occur annually due to unsafe care'. https://www.who.int/news-room/fact-sheets/detail/patient-safety We have asked on this forum what this actually means - 1 in every 10 patients per treatment episode? per year? over a lifetime? I have been unable to find a denominator which would make this statistic meaningful.
Also, how do we define 'harm'? At one end of the spectrum is avoidable death, but the other end of the spectrum is unclear. If a patient has a signficiant but minor side effect from a drug that was given incorrectly or in the wrong dose, is this counted as '1 in 10 patients is harmed'? We wait for answers.
Looking even more broadly, what is the definition of 'unsafe care'? Probably the majority of incorrect decisions and actions made in healthcare do not actually result in harm, but such care remains unsafe.
I was unable to find a definition of unsafe care on the WHO website or in the Global Patient Safety Action Plan.
It could be argued that any decision or action that is not informed by the cumulative available evidence represents 'unsafe care'. In this case every single one of us has most certainly been a recipient of unsafe care at many points in our lives, even if that care did not result in measurable harm.
I look forward to read your thoughts. Email to: hifa@hifaforums.org
Many thanks, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org