Research, knowledge and evidence driving patient safety agenda, says Chief Medical Officer

RESEARCH, knowledge and evidence are at the heart of efforts to improve quality and patient safety in the health services, Chief Medical Officer Tony Holohan has told the third annual UL Hospitals Research Symposium in Limerick.

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Dr Holohan said that while risk could never be eliminated in clinical settings, evidence had to be continuously collected and applied to reduce it.

“In the interests of patients, we have to strive for a culture where, as a routine, we profile risk as it relates to patient safety; we investigate and respond to incidents when they occur; we learn the lessons that can be learned and we apply those lessons in order to minimise the risks of recurrence,” Dr Holohan said.

“Internationally, research and performance-derived data and information in this area is more limited than we might like. A recent meta-analysis of studies using the Global Trigger Tool has produced a new evidence-based estimate. In hospitals alone, preventable adverse events may kill more than 400,000 people per year in the US. In Ireland, a number of high-profile cases in relation to blood-borne virus transmission, vaginal hysterectomy and breast cancer and other high profile cases in relation to patient safety have impacted on society’s trust. In more recent time the concern has focused on maternity services.

“Recent work undertaken by the Irish Medical Council and work undertaken by the Ombudsman has provided some analysis of patient complaints. Examining basic data and information derived from routine operations in this way creates a deeper understanding and intelligence from that data. What we need to see is this intelligence being created from all forms of information relevant to patient safety and being brought together to form a much higher level of intelligence and knowledge about the performance and safety of our health services. That is what I would call patient safety surveillance. Many individual organisations can create a piece of the jigsaw of patient safety within their own roles and remits. A system of surveillance would bring all the pieces together and complete the picture, thereby opening up new understanding new insight and a more intelligence-led response in research, policy and operational terms to the patient safety challenges that we face.”

Dr Holohan said recent and forthcoming initiatives around quality and patient safety were being introduced in this spirit.

“The publication by the Department of Health of a suite of eight prioritised and quality assured national clinical guidelines is a critical step towards the delivery of consistent, safe, evidence-based care across the country and these will sit alongside a significant programme of patient safety legislation which is underway. The government will shortly publish a general scheme for the Health Information and Patient Safety Bill, which will deal with the sharing of information between regulators, clinical audit, quality assurance, adverse event reporting, open disclosure and a number of other matters relating to patient safety. It will also include a more streamlined ethics approval process for health research not already governed by statutory regulation or EU law.”

Dr Holohan’s address also touched on how the fruits of clinical research could prove a huge challenge to modern healthcare systems, particularly on cost grounds.

“Once upon a time, perhaps before the wars, medicine was limited by lack of technical know-how and a limited understanding of the causation and progress of disease. It was more, if you like, about care than cure; and care for those who could not afford to pay a doctor was provided by religious organisations or other voluntary bodies. There was little reason or rationale for the state to become involved in the delivery of healthcare,” he said.

“As science developed, and more and more interventions surgical and medical became possible, the challenge became to ensure they were distributed as quickly and as widely as possible. The state became involved.

“However, expansion of technology and services was not limited by cost to any appreciable extent. This is no longer the case. We have entered a third era in which the ability to provide fully comprehensive services for all  the demands and needs - and a level of quality which we would individually expect and at a price which we as a society are willing to pay, whether that is directly out of pocket or indirectly through tax or insurance - is becoming more and more limited. And this is by no means a uniquely Irish problem. During the second half of the 20th century and in the early years of this century, all developed countries have experienced changes in the relationships between health professionals and society. A large number of effective therapeutic interventions have been developed and, taken together with the ageing population and the burden of chronic health problems, this has resulted in competing demands for the limited financial resources available for healthcare.

“That is part of our everyday reality. As professionals, our first obligation is to understand and accept this. We must then, through the acquisition and development of knowledge through research and innovation, better prevention, improved integration of care, more evidence-based and judicious use of treatment and technologies, try to ensure that the manner in which the resources we have are applied to all patients in our care and in our community, and not just the patient in front of us, so as to ensure the greatest possible benefit for all.”

Dr Holohan was speaking at the third annual UL Hospitals Research Symposium at the Strand Hotel, Limerick.

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Chair of the organising committee, Prof Austin Stack, Foundation Chair of Medicine, University Hospital Limerick and Director Designate of the Health Research Institute at UL, commented: “It is a hugely important event in the calendar and life cycle of UL Hospitals and an event which gives us a huge opportunity to showcase and profile the breadth and depth of research being conducted on the hospital campus and indeed with our partners University of Limerick; in primary care and community care.”

“Importantly, it demonstrates the continued growth in research capability and diversity across our hospital network and university departments. We have had an enthusiastic response from our research community with over 190 scientific abstracts including 18 oral presentations. The scientific committee has taken great care in preparing a high-quality and varied programme that featuring the latest developments and ideas in health services and population health; lifestyle and health; technology and health and clinical research,” added Prof Stack.

This year’s – the biggest hosted by UL Hospitals to date – also featured four keynote speakers in:

  • Dr Tony Holohan, Chief Medical Officer at Department of Health and Children, Dublin Ireland
  • Professor Laurie Morrison, Robert & Dorothy Pitts Research Chair in Acute Care & Emergency Medicine, Professor and Clinician Scientist in the Division of Emergency Medicine, Department of Medicine at the University of Toronto and Li Shing Knowledge Institute at St. Michael’s Hospital. Canada
  • Professor Calvin Coffey, Foundation Chair Surgery, Graduate Entry Medical School, UL & Consultant General and Colorectal Surgeon, University Hospitals Limerick, Ireland
  • Professor Fergus Shanahan, Professor and Chairman of the Department of Medicine at UCC, Ireland