It is a sad fact that healthcare can actually harm the people that it should be helping. This is true and alarming. However, healthcare is a complex process, and it is not surprising that patient safety can be threatened. Our aim in writing this book has been to offer a practical approach to understanding and improving patient safety in both primary and secondary care. We fully accept that we have only provided a small snapshot into the ever-expanding world of patient safety. However, we believe that if the basic principles were applied then patient safety would substantially improve. We would like to thank all of the contributors for their hard work in bringing together the large amount of existing knowledge, the National Patient Safety Agency (NPSA) for reviewing the manuscript to ensure that it fi ts into current trends, and the editorial team at Blackwell Publishing. Patient safety is a major concern for all healthcare providers. It appears perverse that patients can suffer harm when they are being treated and cared for. However, healthcare is complex and its outcome is infl uenced by many factors. It is inevitable that within any healthcare system patients will be harmed, and in every encounter there is the potential for harm to occur. This has been recognized since the time of the physicians of Ancient Greece and Rome – ‘First, do no harm.’ How frequent are threats to patient safety?
In the 1970s, research identifi ed that as many as 36% of admissions to a general medical unit and 13% of admissions to intensive care units followed adverse events in which patients had been harmed, most often as a result of medications (Fig. 1.1). However, it was the publication of the Harvard Medical Practice Study (HMPS) in 1991 that highlighted to healthcare providers and policy-makers the extent of harm. Patient safety was now in the public eye, not only in the USA but throughout the world. The HMPS analysed more than 30 000 randomly selected medical records of recently discharged patients from a random selection of 51 hospitals in New York State. Adverse events, defi ned as extended hospitalization, disability at the time of discharge, or death resulting from medical care, were identifi ed. The proportion of hospital admissions experiencing an adverse event was 3.7%. The proportion of adverse events that were preventable was 58%. These fi ndings were confi rmed in a similar study of acute care hospitals in Colorado and Utah, with 2.9% of admissions experiencing an adverse event, of which 53% were preventable.