Nearly a third of additional serious adverse events associated with care (SAEs) were counted in 2022 compared to 2021, according to a report published by the High Authority for Health (HAS) on the occasion of safety week of patients, from November 20 to 24, 2023. Problems with the organization of care, actions by the patient against himself and medication errors (in dosages in particular) form the top three of these serious events. How to explain this increase? Is it a sign of growing dysfunctions in the health system?
Surprisingly... it’s the opposite, explains the HAS! This increase in figures is in fact “good news, because it is certainly the result of better knowledge of the system and an improving safety culture among professionals”. In 2022 the HAS received 2,385 anonymized reports of EIGS, compared to 1,874 for 2021 and barely 288 in 2017. This does not mean that serious events are more and more numerous, but that they are increasingly better identified and declared by health professionals, whether they work in town, in a clinic or in a hospital.
» READ ALSO - A plea for surgical error
More than half (56%) of these SAEs affect patients over 60 years old. 52% of SAEs are carried out during urgent treatment, and 55.5% concern therapeutic procedures (compared to 11.2% for diagnostic procedures). In addition, almost 4 in 10 occur at night, on weekends or during a public holiday. HAS also notes that particular risks exist in critical care services (resuscitation, continuous monitoring and intensive care) because they involve numerous caregivers, complex technical procedures and various devices, on patients who are by definition fragile. The main errors in these services are the error or delay in support, the lack of monitoring, the complexity of a gesture.
Lifts also vary by region. In 2022, 64 declarations per million inhabitants were made in Auvergne-Rhône-Alpes, 62.2 in the PACA region, and 37.3 in Île de France. At the very bottom of the ranking are the Grand Est region (17.3), Normandy (14.2), New Aquitaine (10.5) and Corsica (8.5). Mayotte and Guyana have not made any declaration. The HAS specifies that “a region with a high number of declarations is not a region where it is more dangerous to seek treatment. This is certainly a reflection of a more advanced safety culture.
» READ ALSO - Medical errors: the patient, actor of his safety
SAEs can have several causes. “Errors linked to care or the organization of care” are the most frequently declared, forming 31.3% of the total in 2022. They include in particular defects and delays in care. This is followed by “actions by the patient against himself (including suicides and suicide attempts)” for 23.6% of reports, and finally “medication errors and adverse effects caused by taking medication” (11.9%). . Other adverse events may occur during an operative or anesthetic procedure, or without an obvious cause being found. Medication dose errors represent 44% of all medication errors reported since 2017, and continue to increase: they represent 58% of the 143 medication errors reported in 2022, warns the HAS.
» READ ALSO - A surgeon allegedly forgot a glove and 5 compresses in a patient's stomach
However, progress remains to be made. Thus, few declarations come from community medicine. The HAS also judges that for more than one in two EIGS, in-depth analyzes are not carried out correctly; may notably lack the description of the detailed chronology of the facts or the identification of the root causes of the EIGS. Regional support structures (SRA) help healthcare professionals declare, analyze and share SAEs. But in 2022, 91% of declarants estimated that they did not need external expertise to carry out the analysis of an EIGS, a stable proportion since 2017. Only 6% of declarants used SRAs, a proportion which is however increasing since it was only 1% in 2017.
The HAS notes that 48% of SAEs cause death, 30% endanger the patient's vital prognosis and 22% probably cause a permanent functional deficit. More than half (51%) of SAEs could have been avoided in 2022. It is therefore important that caregivers and health establishments take more control of the problem. In this report, for 73% of the SAEs declared the immediate causes are clearly identified and the analysis allows, in 60% of cases, to adopt action plans aimed at correcting the problem by taking into account the reality on the ground. The HAS recommends taking into account the patient's opinion on their experience, and plans to publish "safety flashes" intended for healthcare professionals to better raise their awareness of certain issues such as "safety in the operating room" or "medications at risk ". It also encourages professionals to better report these serious events. Transparency is essential to improve the quality and safety of care.