Dr Patrick Bolton, Vice President, Australian Healthcare & Hospitals Association, has some further interesting points to make on surgical safety:
“The recent study which showed that the WHO Surgical Safety Checklist reduced postoperative complications by an average of 36% and resulted in a fall in the total in-hospital death rate from 1.5% to 0.8% takes one in a number of directions.
The first is that some parts of Australia already have a preoperative “time out” procedure during which matters important to patient safety are reviewed. The procedure was introduced in NSW in order to ensure “right patient, right side, right site” surgery.
This is ironic because the chances of being subjected to wrong site surgery are less than one in one hundred-thousand. It seems that we already have a checklist, but it may not be looking at the most important areas. This seems silly.
The WHO Checklist is to be welcomed because it has been shown to make an important difference to patient safety. It can be built on top of existing practice to enhance it.
The second fact is that the overall death rate in Australian public hospitals in 2006-7 was 1.3%. This puts Australian hospitals ahead of the baseline performance of the study hospitals, but behind their performance after introduction of the WHO Checklist.
Professor Chris Baggoley, Chief Executive, Australian Commission on Safety and Quality in Health Care, says that Australian hospitals are already doing many of the things on the WHO Checklist. This means that there must either be important parts of the Checklist that Australian hospitals have yet to implement, or important changes that they could make in other areas of care so that they are achieving at the level of the study hospitals after the Checklist had been implemented.
The further 0.5% reduction in in-hospital death which might be achieved represents around 22,000 preventable deaths annually, over ten times the national road toll.
The third point is that, death rate aside, it will be difficult for Australians to detect the impact of the introduction of improvements such as the WHO Checklist because we are not quantifying adverse outcomes in our health system.
A 1993 study found that 16.6% of Australian hospital admissions were associated with an “adverse event”, and in 4.9% of these cases the patient died. These figures are comparable with those in other Western nations.
Significant investment has been made in quality improvement in healthcare across Australia. Unfortunately the impact of this investment is unknown because the study has not been repeated.
Like the “time out” procedure above, important initiatives are being implemented in suboptimal ways. We can’t know if we are making things better if we don’t measure them.
Finally, change of this kind is not easy, a point made by the HARC eBulletin from the Sax Institute which seeded this blog. A lot more is known about what works than about how to put it into practice.
It is important to support Australian hospitals to implement reform to meet world’s best practice. Moving to a different governance model for the Australian healthcare system is being discussed by some commentators.
Improving the current model through initiatives such as the WHO Checklist may be less risky and more efficient and should be considered as one of the alternatives.
To this end, I would commend to all stakeholders interested in how Australian compares itself accurately with the rest of world to attend the AHHA Congress 2009 in Hobart, Tasmania from 7-9 October.
All of these issues plus more will be addressed, including practical benchmarking sessions along with improving the Australian health system in all areas and how best to achieve this.”