Patient safety as a public health problem

  • Kelly Estrada-Orozco a. Patient Safety Research Unit, Clinical Research Institute, School of Medicine, Universidad Nacional de Colombia. Bogotá, Colombia. b. Clinical Research Institute, School of Medicine, Fundación Universitaria Sanitas. Bogotá, Colombia. c. Adverse Events Analysis Unit, Instituto de Evaluación Tecnológica en Salud (IETS). Bogotá, Colombia. https://orcid.org/0000-0001-5022-5572
  • Hernando Gaitán-Duarte Patient Safety Research Unit, Clinical Research Institute, School of Medicine, Universidad Nacional de Colombia. Bogotá, Colombia. https://orcid.org/0000-0003-2939-3648
  • Javier Eslava-Schmalbach Patient Safety Research Unit, Clinical Research Institute, School of Medicine, Universidad Nacional de Colombia. Bogotá, Colombia. https://orcid.org/0000-0003-1502-2918
Keywords: Patient safety, Public health, Health equity, Quality healthcare, Inequity in health

Abstract

Patient safety is an essential component of quality healthcare, which is what the general population is constantly demanding worldwide. Consequently, ensuring quality healthcare should not be a matter of clinical interest only but a public health priority so that all actions planned or implemented may have an impact at all levels and ensure intersectoral support to help the population remain safe when seeking and receiving health services. The definition and implementation of patient safety are currently circumscribed to the institutional setting. This article aims to present data that can help put into perspective the existing gaps pertaining to patient safety definition and fields of action, and conclude that there is room to work in public health in order to close those gaps. This requires understanding the complexities of the interactions between determinants of harm outside the physical setting where care is provided. These include community-level work, incorporation of knowledge from other disciplines in order to account for coverage, access and health outcomes, design strategies to counteract the impact that the absence of effective patient and people safety measures have on the general population and, in particular, on people differentially affected by the social determinants of health.

References

Organización Mundial de la Salud (OMS). The conceptual framework for the international classification for patient safety. WHO: Ginebra; 2009.

Organización Mundial de la Salud (OMS). 10 datos sobre la seguridad del paciente. OMS: Ginebra; 2019.

Organización Mundial de la Salud (OMS). Patient safety: a global health priority [internet]. 2019 [cited: 2022 Nov 21]. Available at: https://www.who.int/patientsafety/policies/global-health-priority/en/.

Institute of Medicine. To err is human: Building a safer health system. Washington, DC: National Academy Press; 2000.

Organización Mundial de la Salud (OMS). Alianza mundial para la seguridad del paciente. OMS: Washington; 2008.

Organización Mundial de la Salud (OMS). Reto mundial en pro de la seguridad del paciente. OMS: Ginebra; 2005.

Mattie AS, Ben-Chitrit R. Patient safety legislation: a look at health policy development. Policy Polit Nurs Pract. 2007;8(4):251-61. doi: https://doi.org/10.1177/1527154407313467.

Ministerio de Salud y la Protección Social. Política de seguridad del paciente. Lineamientos para la implementación de políticas en seguridad del paciente. Bogotá: MSPS; 2008.

Ministerio de Salud y Protección Social. Lineamientos para la implementación de políticas en seguridad del paciente [internet]. 2008 [cited 2023 Nov 15]. Available at: https://www.minsalud.gov.co/salud/Documents/CalidadAtenci%C3%B3nEnSalud/LINEAMIENTOS%20PARA%20LA%20IMPLEMENTACI%C3%93N%20DE%20LA%20POL%C3%8DTICA%20DE%20SEGURIDAD%20DEL%20PACIENTE%20EN%20LA.pdf

Runciman MA, Walton M. Safety and ethics in healthcare: A guide to getting it right. Londres: CRC Press; 2007. doi: https://doi.org/10.1201/9781315607443.

Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991;324(6):370-6. doi: https://doi.org/10.1056/NEJM199102073240604.

Estrada-Orozco K, Cantor Cruz F, Benavides Cruz J, Ruiz-Cardozo MA, Suárez-Chacón AM, Cortés Tribaldos JA, et al. Hospital adverse event reporting systems: A systematic scoping review of qualitative and quantitative evidence. J Patient Safety. 2021;17(8):e1866-72. doi: https://doi.org/10.1097/PTS.0000000000000690.

Estrada-Orozco K, Gaitán-Duarte H, Moreno S, Moreno-Chaparro J. Reportable hospital events: incidence and contributing factors in the surgery service of a high complexity hospital in Bogotá, Colombia, 2017. Colombian Journal of Anesthesioly. 2019;47:5-13. doi: https://doi.org/10.1097/CJ9.0000000000000091.

Jha AK, Larizgoitia I, Audera-López C, Prasopa-Plaizier N, Waters H, Bates DW. The global burden of unsafe medical care: analytic modelling of observational studies. BMJ Quality Safety. 2013;22(10):809. doi: https://doi.org/10.1136/bmjqs-2012-001748.

OECD. The economist of patient safety: strengthening a value based approach to reducing patient harm at national level. OECD; 2017.

Sousa P, Uva AS, Serranheira F, Nunes C, Leite ES. Estimating the incidence of adverse events in Portuguese hospitals: a contribution to improving quality and patient safety. BMC. 2014;14:311. doi: https://doi.org/10.1186/1472-6963-14-311.

Molina FJ, Rivera PT, Cardona A, Restrepo DC, Monroy O, Rodas D, et al. Adverse events in critical care: Search and active detection through the Trigger Tool. World J Crit Care Med. 2018;7(1):9-15. doi: https://doi.org/10.5492/wjccm.v7.i1.9.

Aranaz-Andrés JM, Aibar-Remon C, Limón-Ramírez R, Amarilla A, Restrepo FR, Urroz O, et al. Prevalence of adverse events in the hospitals of five Latin American countries: results of the 'Iberoamerican Study of Adverse Events' (IBEAS). BMJ. 2011;20(12):1043-51. doi: https://doi.org/10.1136/bmjqs.2011.051284.

Gaitán-Duarte H, Eslava-Schmalbach J, Rodríguez-Malagón N, Forero-Supelano V, Santofimio-Sierra D, Altahona H. Incidencia y evitabilidad de eventos adversos en pacientes hospitalizados en tres instituciones hospitalarias en Colombia, 2006. Rev Salud Pública. 2008;10:215-26. doi: https://doi.org/10.1590/S0124-00642008000200002.

Ovalle D. Diferencias en los costos directos causados por los eventos adversos entre los servicios médicos y quirúrgicos, en una institución de segundo nivel en Bogotá, Clínica Carlos Lleras Restrepo Abril 2009- Marzo 2010. Bogotá: Universidad Nacional de Colombia; 2013.

Así vamos en salud. Tasa de incidencia de infecciones asociadas a dispositivos. Resolución 256/16 [internet]. 2021 [Cited 2022 Nov 21]. Available at: https://www.asivamosensalud.org/indicadores/seguridad-del-paciente/tasa-de-incidencia-de-infecciones-asociadas-dispositivos.

Gaitán H. Los eventos adversos en la atención en salud. Rev Colomb Obstet Ginecol. 2016;4(59):270-2. doi: https://doi.org/10.18597/rcog.389.

Ministerio de Salud y Protección Social. Sistema integrado de la información de la protección Social SISPRO [internet]. 2021 [cited 2022 Nov 21]. Available at: https://www.sispro.gov.co/Pages/Home.aspx.

Vincent C, Neale G, Woloshynowych M. Adverse events in British hospitals: preliminary retrospective record review. BMJ. 2001;322(7285):517-9. doi: https://doi.org/10.1136/bmj.322.7285.517.

Wilson RM, Van Der Weyden MB. The safety of Australian healthcare: 10 years after QAHCS. Med J Australia. 2005;182(6):260-1. doi: https://doi.org/10.5694/j.1326-5377.2005.tb06694.x.

Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, et al. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ. 2004;170(11):1678-86. doi: https://doi.org/10.1503/cmaj.1040498.

Ministerio de Salud y Protección Social. Seguridad del paciente [internet]. 2012 [cited 2022 Nov 20]. Available at: https://www.minsalud.gov.co/salud/CAS/Paginas/seguridad-del-paciente.aspx

Organización Mundial de la Salud. Social determinants of health. The Solid Facts. OMS: Ginebra; 2003.

Marmot WR. Social determinants of health. Oxford: Oxford Press; 2005. doi: https://doi.org/10.1093/acprof:oso/9780198565895.001.0001.

Organización Mundial de la Salud (OMS). The determinants of health [internet]. S. f. [Cited 2022 Nov 21]. Available at: https://www.paho.org/es/temas/determinantes-sociales-salud

Vincent C, Taylor-Adams S, Stanhope N. Framework for analysing risk and safety in clinical medicine. BMJ. 1998;316(7138):1154-7. doi: https://doi.org/10.1136/bmj.316.7138.1154.

Rogers S. A structured approach for the investigation of clinical incidents in health care: application in a general practice setting. BRJ. 2002;52 Suppl:S30-2.

Dirección Administrativa Nacional de Estadísticas (DANE). Encuesta Nacional de Calidad de Vida [internet]. 2012 [Cited 2022 Nov 21]. Available at: https://www.dane.gov.co/index.php/estadisticas-por-tema/salud/calidad-de-vida-ecv/encuesta-nacional-de-calidad-de-vida-2012.

Congreso de Colombia. Ley estatutaria 1751 del 16 de febrero de 2015, Por medio de la cual se regula el derecho fundamental a la salud y se dictan otras disposiciones.

Fernández Sierra M. Barreras de acceso a servicios de salud y mortalidad en Colombia. Foco Económico [internet] 2019. [cited 2022 Nov 21]. Available at: https://focoeconomico.org/2019/10/15/barreras-de-acceso-a-servicios-de-salud-y-mortalidad-en-colombia/.

Ayala García J. La salud en Colombia: más cobertura pero menos acceso. Bogotá: Repositorio Banco de la República; 2014.

Day B. The consequences of waiting. Montreal: Fraser Institute; 2013.

Christopher TB, David E, Anthony H, Christian L, Joanne M, et al. Informe sobre la salud en el mundo. Investigaciones para una cobertura sanitaria universal [internet]. Organización Mundial de la Salud; 2013 [cited 2022 Nov 21]. Available at: https://www.apps.who.int/iris/bitstream/10665/85763/1/9789240691223_spa.pdf.

Imperial College London. Systems analysis of clinical incidents: The London Protocol [internet]. 2004 [cited 2022 Nov 21]. Available at: https://www.imperial.ac.uk/patient-safety-translational-research-centre/education/training-materials-for-use-in-research-and-clinical-practice/the-london-protocol/.

Barua B, Esmail N, Jackson T. The effect of wait times on mortality in Canada. Canadá: Fraser institute; 2014.

Sobolev B, Kuramoto L, Levy A, Hayden R. Methods for studying adverse events on surgical wait lists. Health Services and Outcomes Research Methodology. 2006;6:139-51. doi: https://doi.org/10.1007/s10742-006-0010-3.

Sobolev BG, Levy AR, Kuramoto L, Hayden R, Fitzgerald JM. Do longer delays for coronary artery bypass surgery contribute to preoperative mortality in less urgent patients? Medical Care. 2006;44(7):680-6. doi: https://doi.org/10.1097/01.mlr.0000220257.81482.67.

Cesena FH, Favarato D, César LA, de Oliveira SA, da Luz PL. Cardiac complications during waiting for elective coronary artery bypass graft surgery: incidence, temporal distribution and predictive factors. Eur J Cardiothorac Surg. 2004;25(2):196-202. doi: https://doi.org/10.1016/j.ejcts.2003.11.004.

Fortin A, Bairati I, Albert M, Moore L, Allard J, Couture C. Effect of treatment delay on outcome of patients with early-stage head-and-neck carcinoma receiving radical radiotherapy. Int J Radiat Oncol Biol Phys. 2002;52(4):929-36. doi: https://doi.org/10.1016/S0360-3016(01)02606-2.

Christensen ED, Harvald T, Jendresen M, Aggestrup S, Petterson G. The impact of delayed diagnosis of lung cancer on the stage at the time of operation. Eur J Cardio-thoracic Surg. 1997;12:880-4. doi: https://doi.org/10.1016/S1010-7940(97)00275-3.

Garbuz DS, Xu M, Duncan CP, Masri BA, Sobolev B. Delays worsen quality of life outcome of primary total hip arthroplasty. Clin Orthop Relat Res. 2006;447:79-84. doi: https://doi.org/10.1097/01.blo.0000203477.19421.ed.

Vergara I, Bilbao A, González N, Escobar A, Quintana JM. Factors and consequences of waiting times for total hip arthroplasty. Clin Orthop Relat Res. 2011;469(5):1413-20. doi: https://doi.org/10.1007/s11999-010-1753-2.

Braybrooke J, Ahn H, Gallant A, Ford M, Bronstein Y, Finkelstein J, et al. The impact of surgical wait time on patient-based outcomes in posterior lumbar spinal surgery. Eur Spine J. 2007;16(11):1832-9. doi: https://doi.org/10.1007/s00586-007-0452-5.

Boisjoly H, Freeman EE, Djafari F, Aubin M-J, Couture S, Bruen RP, et al. Reducing wait time for cataract surgery: comparison of 2 historical cohorts of patients in Montreal. Can J Ophthalmol. 2010;45(2):135-9. doi: https://doi.org/10.3129/i09-256.

Así vamos en salud. Tiempo promedio de espera para la asignación de cita de cinco (5) especialidades médicas por IPS-Resolución 256/16 [internet]. 2021 [cited 2022 Nov 21]. Available at: https://www.asivamosensalud.org/indicadores/oportunidad-de-la-atencion/tiempo-promedio-de-espera-para-la-asignacion-de-cita-de-1.

Así vamos en salud. Cobertura de vacunación triple viral en niños de un año [internet]. 2021 [cited 2022 Nov 21]. Available at: https://www.asivamosensalud.org/indicadores/gestion-del-riesgo/cobertura-de-vacunacion-triple-viral-en-ninos-de-un-ano.

Así vamos en salud. Mortalidad por tétanos neonatal – georreferenciado [internet]. 2021 [cited 2022 Nov 21]. Available at: https://www.asivamosensalud.org/indicadores/enfermedades-transmisibles/mortalidad-por-tetanos-neonatal-georreferenciado.

Así vamos en salud. Incidencia de sífilis congénita - georreferenciado [internet]. 2021 [cited 2022 Nov 21]. Available at: https://www.asivamosensalud.org/indicadores/gestion-del-riesgo/incidencia-de-sifilis-congenita-georeferenciado.

Institute of Medicine. Committee on quality of health care in America. En: Kohn LT, Corrigan JM, Donaldson MS, editors. To err is human: Building a safer health system. Washington (DC): National Academies Press (US); 2000.

Wang CCK, Poe HK. Drug and alcohol testing of employees as a function of safety management. Profes Safety. 1991;36(7):29.

Waring J, Allen D, Braithwaite J, Sandall J. Healthcare quality and safety: a review of policy, practice and research. Sociol Health Illness. 2016;38(2):198-215. doi: https://doi.org/10.1111/1467-9566.12391.

Anderson C. Abuse and neglect among the elderly. J Gerontological Nursing. 1981;7(2):77-83. doi: https://doi.org/10.3928/0098-9134-19810201-05.

Ray WA, Griffin MR, Shorr RI. Adverse drug reactions and the elderly. Health Affairs. 1990;9(3):114-22. doi: https://doi.org/10.1377/hlthaff.9.3.114.

Guilbert JJ. The World Health report 2002. Reducing risks, promoting healthy life. Educ Health (Abingdon). 2003;16(2):230. doi: https://doi.org/10.1080/1357628031000116808.

Rocco C, Garrido A. Seguridad del paciente y cultura de seguridad. Revista Médica Clínica Las Condes. 2017;28(5):785-95. doi: https://doi.org/10.1016/j.rmclc.2017.08.006.

Council of Europe. Recommendation of the Committee of Ministers to member states on management of patient safety and prevention of adverse events in health care. 2006.

NHS. Learning from patient safety incidents. NHS; 2010.

Whitehead M. Los conceptos y principios de la equidad en la salud. Washington: Organización Mundial de la Salud; 1991.

Freidson E. Professional dominance: The social structure of medical care: Transaction Publishers; 1974.

Okoroh JS, Uribe EF, Weingart S. Racial and ethnic disparities in patient safety. J Patient Safety. 2017;13(3):153-61. doi: https://doi.org/10.1097/PTS.0000000000000133.

Shen JJ, Cochran CR, Mazurenko O, Moseley CB, Shan G, Mukalian R, et al. Racial and insurance status disparities in patient safety indicators among hospitalized patients. Ethn Dis. 2016;26(3):443-52. doi: https://doi.org/10.18865/ed.26.3.443.

Piccardi C, Detollenaere J, Vanden Bussche P, Willems S. Social disparities in patient safety in primary care: a systematic review. Int J Equity Health. 2018;17(1):114. doi: https://doi.org/10.1186/s12939-018-0828-7.

Stockwell DC, Landrigan CP, Toomey SL, Westfall MY, Liu S, Parry G, et al. Racial, ethnic, and socioeconomic disparities in patient safety events for hospitalized children. Hosp Pediatr. 2019;9(1):1-5. doi: https://doi.org/10.1542/hpeds.2018-0131.

Gardener H, Leifheit EC, Lichtman JH, Wang Y, Wang K, Gutiérrez CM, et al. Racial/ethnic disparities in mortality among medicare beneficiaries in the FL-PR CR eSD Study. J Am Heart Assoc. 2019;8(1):e009649. doi: https://doi.org/10.1161/JAHA.118.009649

How to Cite
1.
Estrada-Orozco K, Gaitán-Duarte H, Eslava-Schmalbach J. Patient safety as a public health problem. Colomb. J. Anesthesiol. [Internet]. 2023 Dec. 15 [cited 2024 Apr. 28];52(2). Available from: https://www.revcolanest.com.co/index.php/rca/article/view/1096

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2023-12-15
How to Cite
1.
Estrada-Orozco K, Gaitán-Duarte H, Eslava-Schmalbach J. Patient safety as a public health problem. Colomb. J. Anesthesiol. [Internet]. 2023 Dec. 15 [cited 2024 Apr. 28];52(2). Available from: https://www.revcolanest.com.co/index.php/rca/article/view/1096
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Narrative review

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