Exploring patient participation in reducing health-care-related safety risks

Exploring patient participation in reducing health-care-related safety risks
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Exploring the key role that patients can play in preventing medical errors in surgery safety
is the domain approached in this chapter. The study draws from the conceptual model
proposed by Longtin et al. (5) (see Chapter 1), in which several factors (relating to HCWs
and patients) that influence patient participation in improving patient safety are considered.
Content of this chapter
The chapter is focused on the experience of Portugal, taking into account improvements
in surgical services and the emphasis placed upon increasing safety, efficiency and
patient satisfaction. Elective surgery is discussed, starting with definitions of surgery and
elective surgery.
Morbidity related to surgical care
WHO defines surgery as: “any procedure involving the incision, excision, manipulation,
or suturing of tissue that usually requires regional or general anaesthesia, or profound
sedation to control pain” (9). Surgery is among the most complex and expensive types
of health service (10). It is believed that major surgery is now occurring at a rate of 234
million procedures per year – 1 for every 25 people (9).
The tremendous progress made in terms of effectiveness and complexity of surgical
care has brought new challenges to improving the performance of the surgical system
and enhancing a strong commitment to quality and safety of services, from the
preoperative evaluation to surgical intervention and postoperative care (11). Major
surgical complications occur in 3–22% of inpatient surgical procedures in industrialized
countries, with a death rate of 0.4–0.8%: almost half of the adverse events recorded
are deemed to have been preventable (9). Technique-related complications, wound
infections and postoperative bleeding are probably responsible for around half of
all surgical adverse events (12). Estimates show that 1 in every 20 hospital patients
contracts HAI every year, and SSIs are the third most common type of infection (17%).
UTIs (27%), lower respiratory tract infections (24%) and BSIs (10.5%) are the other
most common types of HAI (1). Methicillin-resistant Staphylococcus aureus (MRSA) is
isolated in approximately 5% of all HAIs (1).
Although the global incidence and costs are unknown, SSIs are assumed to be a major
cause of death and disability. Infection occurring during a surgical procedure or during
wound healing is expected to complicate approximately 2% of clean surgery and 10% of
contaminated operations (10).
Despite the undeniable improvements in safe practice, complications relating to
anaesthesia remain a substantial cause of death during surgery globally (9). Hypoxia due
to respiratory suppression, injuries due to manoeuvres to control the airway, aspiration,
inadequate resuscitation, hypo- and hypertension, cardiac depression and elevation, and
medication reactions and interactions are all potential life-threatening problems (10).
Three decades ago, a healthy patient undergoing general anaesthesia had an estimated
1 in 5000 chance of dying from complications (9,11). Today, the risk has dropped to 1
in 200 000 in the industrialized world with improved knowledge and basic standards of
care (9−11), and efforts are targeting further risk reduction.