Is Dutch healthcare twice as good? Nivel/Emgo report on adverse events in Dutch hospitals, AprMay 07

Every single victim by medical errors is one too many.
Even after a medical error avoidable damage can be prevented to iatrogenic patients by providing honest information and adequate remedial care.

Prof.G.van der Wal, Inspector-General of the Inspectorate of Healthcare (www.igz.nl)Netherlands, presents in a video the following conclusions of the report, published April 25th 2007:
In 2004 76.000 persons were unintentionally harmed in Dutch hospitals by medical care. The question is, what is the definition of unintentional harm? Do they mean medical errors?
30.000 persons were damaged by avoidable harm. 6.000 persons were permanently damaged by avoidable harm.
2000 persons died due to preventable medical errors.
This means that the amount of permanently damaged persons by medical errors is twice as high as the amount of victims of road accidents.

The results of this report deviate in a serious way from the results of international research. On one hand the numbers are too high as each victim of medical errors is one too many.On the other hand the numbers are considerably lower in comparison to other countries.
According to this report appr. 2000 persons die by medical errors in hospitals. According to international consensus 50% of medical errors is preventable, so another 2000 persons die by non-preventable errors, whatever these might be. This leads to appr. 4000 persons who die by medical errors in hospitals.
Our extrapolation, see epidemiological survey, based on the international consensus of 1 of 1000 hospitalisations leading to death or disability, led to appr. 8000 persons who die by medical errors per year at hospitilisations in the Netherlands. No one contradicted our numbers.
This research leads to a total of appr. 4000 death per year.
The conclusion should then be that medical care is twice as good in the Netherlands as other countries. Is this realistic????
Or are the results of international research not correct and is the report of the National Patient Safety Agency from the UK: Building a memory, preventing risk, reducing harm and improving patient safety ( 2005) not correct? This does not seem plausible.

We certainly appreciate the openness of the involved hospitals to cooperate with this investigation. However we have found several methodological limitations.

– This research is initiated by the Association of Medical Consultants and is done by two medical research institutes, one originally intended for research on primary care (Nivel) and one connected to Free University Hospital VU Medisch Centrum Amsterdam (Emgo). This constitutes self-assessment, which per definition is not independent.
– Prof. G. Van der Wal is not only one of the main researchers but also Inspector-General of Inspectorate of Healthcare. This causes a severe conflict of interests.
– Apparently a medical ethical commission was not involved.
– This report has been a written on the basis of retrospective research. This means that the objects and methods of research were defined retrospectively. Prospective research is more precise as definitions of objects and methods of research are formulated in advance. This method is more reliable.
– The evaluation of the medical records was done by two consultants for each case. This is too restricted. In other examinations three consultants were involved with a backup of ten other persons.
– The research was done by medical consultants of four medical departments; internal medicine, surgery, neurology and pediatrics. Other specialities were excluded. Thus this implies a limitation of medical expertise.
РThe research is only based on review of medical records. The researchers themselves acknowledge that 76% of the medical records of this research was not adequate. This is a well known fact acknowledged by the top lawyer of the Dutch Medical Association Legemaate in his inaugural speech 2006. Also the Healthcare Inspectorate as well as the Medical Association of Consultants and Medical Association confirm that medical records are often inadequate.
Reports written by patients were not included in this research. Several studies acknowledge the importance of reports of medical errors by the involved patients.
– Terminal ill patients sometimes prefer to be with their family at home. Their deaths are not included in this research.
– The research involves unintentional harm. This excludes intentional harm caused by deliberate refusal providing open and honest information on the occurrence of a medical error and of neglect of adequate follow-up diagnostics and adequate remedial medical care to victims of medical errors. Several cases of inadequate hospitalisations leading up to six months without diagnostics nor treatment are known to us.

Conclusion IEU-Alliance
On May 8th 2007 Chief-Inspector patient safety Jan Vesseur of the Inspectorate of Healthcare acknowledged that the numbers of victims of medical errors of the Nivel/Emgo report were incorrect, and should be at least doubled, in order to be realistic.

The research of Nivel/ Emgo is incomplete, not independent and does not meet basic methodological requirements. Adequate independent and true scientific research to examine preventable damage in hospitals is urgently necessary. This is also necessary for medical errors in primary care, medical care in nursing homes, social legislation medical care and psychiatry. We need to know in order to be able to improve. Each victim of a medical error is one too many.