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This article is an important step forward in understanding the financial as well as human impact of patient safety events in Canada. My own long term hope is to shift attention from patient safety efforts as "cost centres" to seeing the reduction of harm as "income centres". I would like to raise two issues.
One area that remains to be developed is our understanding of and methods of calculating the financial consequences experienced by the patient, family and community after an adverse event or critical incident has occurred. This is not an easy calculation and significant efforts by the Patient Safety Team at the Winnipeg Regional Health Authority more than a decade ago was a frustrating (and unsuccessful) experience. At the time we were looking at only the consequences of patients who had suffered a hip fracture as a result of a critical incident during the provision of care (both pre-hospital and in-hospital). These costs (loss of income, disruption of family and community relationships, etc.) should be included and will undoubtedly increase several fold the total costs associated with patient safety harm events.
The second issue involves identifying harm that arises from treatment provided in the private healthcare sector, whether in individual physician offices or free standing ambulatory care centres offering relatively complex same day interventions. There is good reason to believe, based on research in the US, that care provided in private facilities is no safer than that provided in public healthcare systems.[1] There is no simple way of tracking these cases and in Canada, the entire cost of subsequent treatment and rehabilitation is borne by the public system. Perhaps I have missed something in your methodology but I could not see how your study would have identified such cases and thereby would not have included them in your calculations. Please let me know if I am wrong on this point.
Sincerely,
Robert Robson, MDCM, MSc, FRCP(C)
Principal Advisor
Healthcare System Safety and Accountabililty, Inc.
References
1. Thomas EJ, Orav EJ, Brennan TA. Hospital ownership and preventable adverse events. J Gen Intern Med 2000;15:211–9.