Patient harm is the 14th leading cause of the global disease burden. This can be compared to tuberculosis and malaria. The majority of this burden falls on the developing countries.
• Most research on the cost of patient harm has focused on the acute care setting in the developed world where the disease burden can be compared to chronic conditions such as multiple sclerosis and some types of cancer.
• The financial impact of safety failure is considerable. Approximately 15% of total hospital activity and expenditure is a direct result of adverse events. The most burdensome adverse event types include venous thromboembolism, pressure ulcers, and infections
• Less is known about harm in primary and ambulatory care. Research indicates that wrong or delayed diagnosis is a considerable problem. Some studies suggest that every adult in the United States can expect to be harmed as a result of diagnostic error at some point in their lifetime.
• The flow-on and indirect costs of harm include loss of productivity and diminished trust in the healthcare system. In 2008, the economic cost of medical error in the US was estimated to be almost USD 1 trillion.
• Many adverse events are preventable. Furthermore the costs of prevention are dwarfed by the cost of failure. For example improving patient safety in US Medicare hospitals is estimated to have saved USD 28 Billion between 2010 and 2015.
Most research to date has focused on the hospital setting. Estimates vary, but around one in ten patients can be said to be harmed during hospital admission. The majority of adverse events relates to healthcare-associated infection, VTE, and adverse drug events or medication error. A Portuguese study of hospital records estimated that three out of five adverse events occurred in elderly patients. Most frequently adverse events were related to surgical procedures (27%), medication errors (18.3%) and healthcare-acquired infections (12.2%) (Sousa et al, 2014). In the long-term care setting, the most frequent adverse events include pressure injury and adverse drug events. For example, a study of facilities providing long term care to Medicare beneficiaries in the United States found that pressure injury, falls, aspiration pneumonia and drug-induced delirium to be the most common types of harm (Levinson 2014).
The economics of patient safety link