Safe care starts with accurate diagnosis!

Since 2019, World Patient Safety Day has been celebrated across the world annually on 17 September, calling for global solidarity and concerted action by all countries and international partners to improve patient safety. The global campaign, with its dedicated annual theme, is aimed at enhancing public awareness and global understanding of patient safety and mobilizing action by stakeholders to eliminate avoidable harm in health care and thereby improve patient safety.

The theme for this year’s World Patient Safety Day’s is focused on improving diagnosis for patient safety, using the slogan

“Get it right, make it safe!”.

A Correct Diagnosis Lays Path to the Most Promising Treatment

A diagnosis identifies a patient’s health issue and is key to obtaining the care and treatment they require. A diagnostic error is defined as the failure to provide a correct and timely explanation of a patient’s health problem, which can involve delayed, incorrect or missed diagnoses, as well as a failure to communicate that explanation with the patient.

Diagnostic safety can be considerably improved by addressing the different factors that contribute to diagnostic errors. Systemic factors are organizational flaws that contribute to diagnostic errors, such as communication breakdowns between health workers or health workers and patients, severe workloads, and inadequate teamwork. Intellectual factors include physician training and experience, as well as a susceptibility to biases, exhaustion, and stress.

“First, do no harm” — The Definition of Patient Safety

The most essential principle of any health-care service is not to cause harm. Nobody should be harmed in health care. However, there is conclusive proof that there is a substantial burden of preventable patient harm worldwide, spanning both industrialized and developing health-care systems. This has significant human, moral, ethical, and financial implications.

Patient safety is defined the the World Health Organization as “the absence of preventable harm to a patient and reduction of risk of unnecessary harm associated with health care to an acceptable minimum.”

Common Sources of Patient Harm

Medication errors:
Medication-related harm affects 1 out of every 30 patients in health care, with more than a quarter of this harm regarded as severe or life threatening. Half of the avoidable harm in health care is related to medications. This does not necessarily mean that a doctor prescribes the wrong pill. Even when the explanation of how to take that pill — fasting, with food, in the morning or evening — has failed to reach the patient, the medication might fail to be effective.

Surgical errors:
According to the Global Surgery 2030 Commission, over 300 million surgical procedures are performed each year worldwide. Surgical errors continue to occur at a high rate. The NIHR Greater Manchester Patient Safety Translational Research Centre calculated, that 10% of preventable patient harm in health care was reported in surgical settings. The performance of a surgical time-out has become a widespread strategy to reduce surgical errors. The surgical team pauses and reviews the patient’s identity, the consent form, the procedure being performed, and the correct anatomical structures and side involved, which should be marked on the patient’s skin.

Health care-associated infections:
Hospital-acquired infections are called nosocomial infections and often involve multi-resistant bacteria, which are difficult to treat. According to a review published in 2023 by the Iran University of Medical Sciences in Tehran and the universities in Newcastle and Glasgow, UK, health care-associated infections globally affect around 1–2 in 1000 patients. They result in extended duration of hospital stays, long-standing disability, increased antimicrobial resistance, additional financial burden on patients, families, and health systems, and avoidable deaths.

Sepsis:
Sepsis is a serious condition that happens when the body’s immune system has an extreme response to an infection. The body’s reaction causes damage to its own tissues and organs. The German Robert Koch Institute in Berlin and several WHO affiliations stated that of all sepsis cases managed in hospitals, around one quarter was found to be acquired in the hospital itself. And approximately one quarter of the affected patients lost their lives as a result.

Diagnostic errors:
Depending on the clinical setting and healthcare systems, diagnostic errors are frequent and may occur in 5–20% of physician–patient encounters. Not all of them have severe consequences. However, according to doctor reviews, harmful diagnostic errors were found in a minimum of 7 out of 1000 adult patients admitted to a hospital.

Patient falls:
Patient falls are the most frequent adverse events in hospitals. Their rate of occurrence ranges from 3 to 5 per 1000 bed-days, and more than one third of these incidents result in injury, thereby reducing clinical outcomes and increasing the financial burden on systems.

Venous thromboembolism (VTE):
More simply known as blood clots, venous thromboembolism is a highly burdensome and preventable cause of patient harm, which contributes to one third of the complications attributed to hospitalization. The primary goal of pharmacologic VTE prophylaxis is to prevent fatal embolism of lung arteries (pulmonal embolism, PE). Patients undergoing surgery, medical hospitalization, cancer treatments, and those with COVID-19 infection routinely receive preventative anticoagulant treatments when the benefits of such treatments are known to outweigh the risks.

Pressure ulcers:
Pressure ulcers are injuries to the skin or soft tissue. They develop from pressure to particular parts of the body over an extended period, especially in bed-ridden patients. If not promptly managed, they can have fatal complications. Pressure ulcers affect more than 1 in 10 adult patients admitted to hospitals and, despite being highly preventable, they have a significant impact on the mental and physical health of individuals, and their quality of life.

Unsafe transfusion practices:
Unnecessary transfusions and unsafe transfusion practices expose patients to the risk of serious adverse transfusion reactions and transfusion-transmissible infections. WHO Data on adverse transfusion reactions from a group of 62 countries show an average incidence of 12.2 serious reactions per 100.000 distributed blood components.

Unsafe injection practices:
Each year, 16 billion injections are administered worldwide, and unsafe injection practices place patients and health and care workers at risk of infectious and non-infectious adverse events. Using mathematical modelling, a study estimated that, in the period from 2000 to 2010, around 1.7 million hepatitis B virus infections were associated with unsafe injections.

Patient misidentification:
Failure to correctly identify patients can be a root cause of many problems and has serious effects on health care provision. It can lead from wrong pills to catastrophic adverse effects, such as wrong-site surgery. Therefore, quality ensuring routines are crucial for hospitals.

System Approach to Patient Safety

Most mistakes that cause harm are caused by system or process problems rather than the behaviors of one or a group of health and care personnel.

Understanding the root causes of medical errors necessitates a move from the old blaming approach to a more system-based perspective. Errors are attributed to poorly designed system structures and processes, and the human nature of all those working in health care institutions under high stress in complex and rapidly changing situations is acknowledged.

A safe health system prioritizes safety by ensuring leadership commitment, creating a safe working environment, building competencies, improving teamwork and communication, and engaging patients and families in policy development.

Investing in patient safety positively impacts health outcomes, reduces costs related to patient harm, improves system efficiency, and helps in reassuring communities and restoring their trust in health care systems.

Action on Patient Safety

The Global Patient Safety Action Plan 2021–2030 provides a framework for action for key stakeholders to join efforts and implement patient safety initiatives in a comprehensive manner. The goal is “to achieve the maximum possible reduction in avoidable harm due to unsafe health care globally”, envisioning “a world in which no one is harmed in health care, and every patient receives safe and respectful care, every time, everywhere”.

In March 2024, the Ministry of Health and Prevention (MoHAP) has announced the launch of the Patient Safety Friendly Hospitals initiative, a significant step in its strategy to guarantee the provision of high-quality healthcare services in line with international best practices. The first two hospitals in the country to obtain the title of “patient safety-friendly hospitals” were evaluated and accredited: Fujairah Hospital of the Emirates Health Services and Mediclinic City Hospital.

Independent Second Opinion — Our Contribution to Patient Safety

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