WHO and its partners call for increased research to improve patient safety

They emphasized the need for intensified research at an international conference that opened today in Porto, Portugal. The conference on Patient safety research: shaping the European agenda will examine evidence showing that harm from medical care poses a substantial burden in terms of suffering and death in Europe and around the world.

WHO estimates that tens of millions of patients worldwide endure disabling injuries or death each year, directly attributed to unsafe medical practices and care. In Europe alone, an average of one in every 10 patients admitted to hospital suffers some form of preventable harm. But more research is needed to better understand the full impact of poor patient safety.

The conference, supported by the European Commission, will promote dialogue between researchers, policy-makers and other constituencies in health care in Europe, and build international collaborative research networks. "Research in patient safety offers all WHO Member States a major innovative resource to assist their hospitals in avoiding harm from medical care and ensure that health care reduces patient suffering and does not contribute to it," said Sir Liam Donaldson, Chief Medical Officer for England, who chairs the WHO World Alliance for Patient Safety. "European countries now have the opportunity to translate research findings into tangible actions that can actually save lives."

The conference will build on the work of the WHO World Alliance for Patient Safety and the contribution of the participating scientists and government officials. It will offer opportunities to promote dialogue between researchers, policy-makers and other constituencies involved in health care in Europe. It is jointly organized by the Faculty of Public Health, UK, University College London and the WHO World Alliance for Patient Safety.

Much of the existing research evidence on the burden of harm in health care is from developed countries, although some evidence from developing nations suggests that unsafe care is a major problem there too. Research is needed not only on individual health care areas, but also on the underlying processes and organizational structures that contribute to unsafe care.

Areas where further research is needed include:

• Health care-associated infection: Infection caused during health care is estimated to affect some 1.4 million people at any given time. In developed countries the toll is 5% to 10% of patients and in some developing countries, as many as a quarter of patients may be affected. With the sharp rise of antimicrobial resistance in the world, it is key that research now focuses on antimicrobial resistance and the spread of multidrug resistant pathogens.
• Adverse drug event: Research estimates show that between 7% and 10% of patients in acute care settings experience an adverse drug event of which some 28-56% are preventable. Hospital admissions due to adverse drug reactions may be more than 10% of the total in some countries. More research is needed in this area, focusing on developing countries, where, it is suggested, rates of adverse drug events are even higher than in the developed world.
• Surgery and anaesthesia: These are among the most complex procedures for health systems to deliver and can be among the costliest. Evidence in developed countries indicates that adverse events in the operating room account for at least 50% of all adverse events. In developing countries, surgical care is constrained by poor facilities, lack of trained staff, inadequate technologies and limited supply of drugs and materials. Research is needed to explore the reasons for geographical differences in the incidence of surgical and anaesthesia errors.
• Unsafe injection practices: Data show that worldwide up to 40% of injections are given with syringes and needles reused without sterilization and in some countries this proportion is as high as 70%. Unsafe injection practices cause an estimated 1.3 million deaths each year worldwide, a loss of 26 million years of life and an annual burden of US$ 535 million in direct medical costs. Future research should focus on evaluating the impact of injection practices on the burden of diseases transmitted through unsafe injections.
• Unsafe blood products: About 5-15% of HIV infections in developing countries are estimated to occur due to unsafe blood transfusions. A WHO study showed that about 60 countries were not able to screen all donated blood for one or more infections including HIV, and other blood-borne infections. Research is urgently needed on the broader aspects of blood safety, including the effectiveness of blood safety strategies and behaviour risk factors among blood donors, particularly in developing countries.
• Adverse medical device events: In the United States, more than 1 million such events occur annually. In some developing countries as much as half of medical equipment is unusable or only partly usable. Effective research and surveillance programmes are needed to detect types, frequency and clinical settings of such events.