Summary of the Evidence on Patient Safety: Implications for Research

World Health Organization. Summary of the evidence on patient safety: implications for research. World Health Organization 2009.

Unsafe medical care is a major source of morbidity and mortality throughout the world. In order to understand the scope of the issues facing policy-makers and researchers involved in improving the safety of health care, the World Health Organization (WHO) World Alliance for Patient Safety convened an ad-hoc expert working group to advise on the priorities for research on patient safety. To facilitate this work, the group used a framework for identifying topics in patient safety and the clinical and organizational issues that are central to improving it. As patient safety is a critical component of the quality of health care and is often described as a prerequisite for high-quality care, the group chose a framework that has been used previously to describe the three components of quality: structure, process and outcomes.

The aim of the report was to summarize existing research on patient safety and to set priorities on that basis. The group identified specific clinical outcomes (such as health care-associated infections), underlying structural problems (such as lack of a trained workforce) and procedural mechanisms (such as poor communication between clinicians) that contribute to unsafe care. On the basis of the epidemiology of patient safety and expert opinion, the group identified 23 topics that have a substantial impact on the safety of medical care and asked experts to describe how each issue affects patient safety.

This report contains several key findings. First, the available data suggest that harm from medical care poses a substantial burden in terms of morbidity and mortality on people around the world. Second, much of the evidence base has been created in the developed nations; although there is some epidemiological evidence of poor clinical outcomes due to unsafe medical care in developing countries and countries with economies in transition, the information on structural and process factors that contribute to unsafe medical care is derived almost entirely from a small number of developed countries. Their applicability to patient safety in other countries is not well known. Finally, although some of the means for reducing harm are known, large gaps in knowledge need to be filled before comprehensive solutions can be found.

In the light of these findings, the Working Group made several recommendations. First, better understanding is required of the causes, frequency and harm of adverse events in developing countries and those with economies in transition. Secondly, special focus should be placed on understanding the underlying processes of care that lead to adverse events. As the epidemiology and causes of adverse events become better known, it will become possible to find the solutions that are most likely to reduce harm.

This report was prepared as a complementary input to the deliberations of the expert group. Its goal is to summarize current knowledge and highlight major gaps in the main areas associated with patient safety. It is meant to serve as a basis for discussions about priorities. Current knowledge suggests that substantial harm can occur from medical care, but limitations in knowledge, especially for developing countries, make it difficult to recommend strategies for reducing that harm. The next generation of research should therefore focus on demonstrating reductions in harm from medical care, to ensure that health care is a balm for human suffering and not a contributor to it.

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