Canada is lagging other wealthy countries when it comes to patient safety, according to new data that show our country’s hospitals record significantly higher rates of obstetrical trauma, as well as foreign objects, such as sponges and instruments, left in patients after surgery.
The data, released Thursday by the Canadian Institute for Health Information (CIHI), compared multiple health indicators measuring the state of Canada’s health-care system against those of a total 35 other member countries of the Organization for Co-operation and Development (OECD). While Canada performed better in some areas, with higher than average rates of survival of breast cancer, colon cancer and rectal cancer, it fared significantly worse on four out of five patient-safety indicators.
In Canada, 553 foreign objects were left inside a patient’s body after surgery over the past two years. This occurred at a rate of 9.8 for every 100,000 hospital discharges – up from 8.6 per 100,000 five years ago, CIHI reported. By comparison, the average OECD rate is 3.8 for every 100,000 discharges.
Meanwhile, the rates of obstetrical trauma, or vaginal tears during childbirth, both with and without the use of instruments, were at least twice as high as the OECD average. The rate of pulmonary embolism, or lung clots after hip or knee surgery, were nearly double the average.
“When we emphasize things like we are – that patient safety is a bit of a challenge here … we hope that the different folks in charge in the health systems across the country will look at their data,” said Tracy Johnson, CIHI’s director of health system analysis and emerging issues. “And when they see someone else has a better outcome than they do, it’s an opportunity to learn."
CIHI, an independent, non-profit organization, releases this data every two years, coinciding with the publication of OECD’s Health at a Glance report. While a total of 36 OECD countries were included in this year’s report, not all countries had data for each health indicator.
For instance, Ms. Johnson pointed out some countries do not count the number of foreign objects left in a patient. So Canada’s high number in this area may reflect its ability to better record these incidents, she said.
Still, leaving a foreign object in a patient is considered a “never” event – that is, the goal is for these incidents to never occur, she said.
Multiple factors can contribute to surgical incidents, including fail-safe issues, such as not following a process or protocol, communication issues and issues related to physicians’ decision-making and situational awareness, according to a 10-year review of surgical safety published in 2016 by the non-profit Canadian Medical Protective Association (CMPA). The CMPA provides medical-liability protection for physicians, and the Healthcare Insurance Reciprocal of Canada.
When it comes to obstetrical injury, a recent study in the Canadian Medical Association Journal found the use of episiotomy, or surgical vaginal incisions to aid in childbirth, has declined in Canada, while anal-sphincter injuries during childbirth are on the rise. The authors suggested episiotomy should be considered in vaginal births involving instruments, especially forceps.
Sandi Kossey, a senior director of the Canadian Patient Safety Institute, said that while there have been efforts to improve patient safety across the country, Canada’s worse-than-average performance in this area is alarming.
“Behind every [one] of those numbers is a patient’s life, a patient’s quality of life,” Ms. Kossey said, adding that these types of incidents can require longer hospital stays, further treatments and additional surgeries, and can sometimes result in death – all of which can be prevented.
Ms. Kossey said patients should feel empowered to speak up and ask questions when something doesn’t look right or feel right. She added that health-care professionals can prevent incidents such as leaving foreign objects in patients by adhering to clinical guidelines and best practices, including ensuring good team work and communication, and following surgical checklists.
The CIHI data showed Canada was close to the average on 32 of the 57 health indicators, and performed better than average on 13 of them.
Ms. Johnson suggested Canada’s higher-than-average survival rates for some cancers, in the quality-of-care category, may be the result of measures such as screening, early detection and good treatment.
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