Improved Safety in Some Contexts

While we cannot know exactly what new risks will arise we can at least anticipate some of the areas in which safety may either be enhanced or threatened; some classic hazards will probably decline while others will increase or change in nature. We are mainly concerned with outlining potential new risks but it is important to balance this with an illustration of how innovations and changing patterns of care can bring dramatic improvements in safety.

Healthcare acquired infections have been one of the greatest challenges of recent years and, in some countries, one of the most visible successes in enhancing safety. For instance, surgical site infections are among the most common healthcare associated infections, accounting up to 31 % of healthcare-associated infections in hospitalized patients. However the incidence of clinical significant surgical site infections (CS-SSIs) following low-to moderate-risk ambulatory surgery in low risk patients is declining rapidly through a combination of shorter length of stay and new operative techniques and technologies (Owens et al. 2014). With 80 % of surgery becoming day surgery, nosocomial infection could even become a minor safety issue rather than one that dominates the safety agenda as it has in recent years. This is a radical example of the power of innovation, both in new technologies and organisation of care, in tackling problems that resisted the efforts of even sustained classic quality and safety improvement efforts at the frontline.

Infection and anti-microbial resistance is of course a massive and continuing challenge and remains a major threat to the health of the population, particularly older people with a number of co-morbidities (Yoshikawa 2002; Davies and Davies 2010). We are simply arguing that innovations in surgical care and changing patterns of delivery may well result in a decline in certain types of healthcare acquired infections and therefore a changing pattern of risk.

New Challenges for Patient Safety

Evolution in healthcare, or indeed in any industry, inevitably bring new risks as well as benefits. Some risks arise directly from new technologies and from new forms of organisation. Other risks come, as we have argued, from the very increase in standards that innovation brings as clinical teams and organisations struggle to adapt to the new expectations. For instance, patients are being discharged earlier from hospital after surgery. This is clearly beneficial but, concomitantly, brings new risks. Errors in post-operative care and errors in non-operative management already cause more frequent adverse events than errors in surgical technique (Anderson et al. 2013; Symons et al. 2013). These trends will probably continue and even accelerate.

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