Consumer Protection In Healthcare Flashcards
Bad doctors ? Context …
Mid Staffordshire and Francis report 2013
Bristol Royal infirmary - paedaetric cardiac surgery in the late 1980s
Harold shipman - Gp in Yorkshire and Manchester
Gynaecological surgery - Canterbury (ledward)
Cause of preventable patient deaths …
Many exaggerated media reports esp in media
Poor clinical monitoring , diagnostic errors and inadequate drug and fluid management in near equal parts
Avoidable mortality
Patients death is judged avoidable if there was a problem in care that contributed to death .
Problems in care are defined as :
- acts of omission (e.g failure to treat according to best evidence )
- acts of commission ( incorrect treatment or management )
- unintended harm due to complications of care
Avoidable death effects occur in estimated 3.6% of hospitals deaths and <0.1 % of hospital admissions
Hospital spells - 13,536,674 , deaths - 274,455(2.03% of spells ) , avoidable deaths - 9,880 (0.07% of spells )
Causes of deaths
Thoracic and respiratory - 31% Abdominal 12% Intracranial -10% Cardiac -8% Renal - 6% Viral - 6% Hepatio biliary tumour - 4% Blood 3% Limb Trauma -3% Renal procedures - 3% Other - 14%
3 broad categories of admissions account for over half of of deaths ( thoracic +respiratory , abdominal , intracranial )
Patients aged 65+ account for one third of admissions , four fifths of deaths and patients aged 75+ and over are 66 times more likely to die following admission than patients aged under 35
Risk of death varies widely by type of admission 0.0% for different HRGs and 78.5% for cardiac arrest , complication score 0-4
USA error rates - IOM report 2000
Error rates of 3-5% means
Medical errors in hospitals kill 44,000-98,000
Americans each year
Errors kill more Americans than motor vehicles accidents or breast cancer or AIDS
Medication drug errors in the USA annually kill three times the number killed at 9/11
Medical errors still the third leading cause of mortality in the USA
Types of medical errors
Medication. - wrong drug , wrong dose
Surgery - wrong procedure I.e paediatric kidney surgery and fail fire to use surgical check lists of airline pilots
Infection control
English error rates
London study of 2 hospitals estimated an reverse event rate of 10.8%
Guesstimated costs of unsafe care in the NHS of £1.2.5 billion
Is UK patient safety improving
Targeted efforts to reduce MRSA and CDIFF infection rates involved reporting and fines can be effective but not costless
Intro of never events and fine since 2011
- serious largely preventable patient safety incidents that should not occur if existing national guidance or safety recommendations have been implemented by healthcare providers
Problem is reporting - are all events reported by busy doctors and nurses
Consumer protection
Notion of caveat emptor - let the buyer beware
Patients should be warned that procedures are risky I.e hernia repairs and PROMS data
Patient choice should be informed but at what cost and how ?
E.g prostate surgery and screening - shared decision making and decisions aids
What is good quality in healthcare ?
Organisational structure of healthcare - usual focus of reform
Does altering structure lead to changes in processes of care by which treatment is delivered to patients
Do alterations in processes of care lead to improved outcomes for patients
Outcomes are of primary Importance - mortality , QALY , patient reported outcome measures (PROMS) , improved length
Doctor patient relationship
Based on trust - consumer assuming doctor will make decision that are in best interests of the patient
- to do no harm
- to improve functioning of elective patients
- to manage emergency patients efficiently ?
- to manage health of chronically ill ?
- to ensure a compassionate and caring death eg end of life pathway
Importance of trust - Confucius said 3 things needed for government: weapons , food and trust if ruler can’t hold only all 3 give weapons first then food and trust last as without it we cannot stand - patients need to trust their physicians and nurses but increasingly this is challenged
Trust and contracts
Contracts are expensive to design and never complete it is impossible to legislate everything doctors do
Professionalism and clinical autonomy- contracts aren’t complete so need trust to manage programmed activity as we have to rely on trust rather than detailed control of activity
Transparency as an aid to trust
4 questions :
What do I produce - volume , case mix , cost and outcome
How much do I produce - relative to me peers
How do I provide care what criteria do I use to distinguish old from new tech
To whom do I deliver care- eg by social class ?
Why is consumer protection necessary ?
Medical practice has 3 deficiencies internationally
Medicine is a weak evidence base
Large variations in clinical practice - doctors do give different treatments to patients with similar needs and personal characteristics
Failure to measure success ( outcomes ) in health care
What data are avaible to improve patient safety ?
Hospital episode statistics (HES)- incl referring GP , procedures given , duration of stay and discharge /death
Lack of basic national data in primary care
Patient reported outcome measurement (PROMS ) before procedure and after quality of life assessment slowly developing
Reference cost data - cost data are poor
