Issue 9 / 17 March 2014

JUST over a week ago it was revealed that a passenger plane carrying 239 people from Kuala Lumpur to Beijing had failed to reach its destination.

In the absence of an identified accident scene, or indeed any information about the plane’s fate, the media depicted the incident using the only images available: distraught family and friends as they learned that the very worst appeared to have happened.

Expressions of compassion flowed from around the world. We didn’t need to see floating debris or a burning fuselage to recognise the suffering that would result from an aviation mishap of this scale.

Medical safety experts have gained some traction from comparing aviation safety to health care safety. While the analogy can only be taken so far, it is useful in the context that many medical errors arise from “systems failure”; that detection, measurement and open disclosure of suboptimal outcomes is key to future prevention; and that major incidents probably reflect the tip of an iceberg of risks that need to be modified.

MJA InSight this week touches on the second of these points — the prosaic process of monitoring the problem areas of health care in an effort to do better.

A study, published in the MJA, reporting the first 3 years of data from a statewide surveillance system for Staphlococcus aureus bloodstream infections in Victoria is the subject of our first news story.

When the latest National Health Performance Authority (NHPA) statistics report on the same problem were released last week, NHPA CEO Dr Diane Watson said: “It is important to remember that every case of healthcare-associated S. aureus bloodstream infection is potentially preventable.”

Given that the Victorian system provides detailed and timely information on when, how, why and in whom these infections occur, we asked experts if it was something that should be emulated nationally.

Clostridium difficile infection (CDI) has also been on the radar of health care safety experts following outbreaks of a severe strain overseas, and is the subject of another MJA InSight news story. In response to the Australian Commission on Safety and Quality in Health Care’s recommendation that CDI be monitored in hospitals throughout the country, a new MJA study representing 2 years of painstaking data collection provides the most coherent picture yet of CDI in Australia.

Monitoring outcomes to inform practice can be difficult in disciplines where there is constant innovation. Another of our news stories looks at the rapidly evolving area of surgery for lower limb complications of diabetes.

Partial foot, rather than below-knee, amputation is increasingly preferred for patients requiring surgery but assuming that less is better in this case is not straightforward.

Hospital-in-the-home (HITH) is at least as safe as inpatient care for the range of conditions in which it has been studied. However, after a recent tragic case in Victoria, we asked HITH expert, Dr Gideon Caplan, to comment on what the facts of the case, carefully elucidated by the coroner, can teach us about avoiding this worst of all outcomes.

You might ask what compassion has to do with patient safety but, in a comment this week, Professor Kim Oates makes the argument that it needs to underpin every aspect of patient care, using the example of the Francis inquiry into poor care and high mortality rates among patients at the Stafford Hospital in England.

In a response to the inquiry’s findings, UK Secretary of State for Health Jeremy Hunt said: “I want our NHS to be a beacon across the world not just for its equity, but its excellence. I want it to offer the safest, most compassionate and most effective care available anywhere — and I believe it can.”

Compassion is something we show towards those who are going through the worst of times. But it is also an underestimated driver of the painstaking application of everyday actions in health care that provide the best chance of protecting patients from avoidable harm.

 

Dr Ruth Armstrong is the medical editor of MJA InSight.

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