Health First Europe Interim Executive Director Brandon Mitchener reviews issues around health inequality and patient safety in clinical settings.
Over the past few months the word ‘inequality’ has cropped up in many discussions of public health priorities in Brussels. While inequality in healthcare is nothing new, the coronavirus crisis has renewed the attention of the European Commission on the lack of a level playing field for healthcare across Europe. This applies to access to healthcare—or lack thereof—as well as the quality of care.
In fact, COVID-19 and the increased volumes of patients entering intensive care units (ICUs) have merely amplified the inequalities that already existed across Europe. This is because antimicrobial resistance and healthcare-associated infections (HAIs) such as sepsis and catheter-associated urinary tract infections (CAUTI) go hand in hand with increased hospitalisations and intensive care stays. The more people there are in intensive care—which is the case all across Europe today—the more infections and the greater the recourse to antibiotics.
Since its start in 2004, Health First Europe has evangelised the importance of education and training, secondary prevention, the integration of health and social care, and innovation as essential means to the ends of improved patient health and quality of life. There is only so much that governments and healthcare professionals can do to prevent people from getting diseases in the first place: ultimately, it is up to individuals to decide whether to follow the advice of governments and other public health authorities on how to avoid catching the coronavirus. Once a citizen crosses the threshold into the professional space of a hospital and becomes a patient, however, he or she has the right to expect the best treatment available and the application of best practices to avoid catching something else than what they entered the hospital with.
Adverse events in hospitals
The reality of endemic HAIs and AMR was already sobering before the pandemic hit.
As many as 12% of patients in European hospitals suffer from some form of adverse events, many of which are preventable. The European Centre for Disease Prevention and Control (ECDC) estimates that approximately 8.9 million infections occur each year in EU healthcare settings. Tragically, some of these lead to sepsis, which claims as many as 37,000 Europeans’ lives each year. The ECDC says HAIs cost Europe about €7bn per year in direct costs alone, not to mention all the knock-on costs of patient suffering and lost productivity. According to the World Health Organization (WHO), avoidable patient harm is the 14th leading cause of disease burden globally, alongside diseases such as malaria and tuberculosis, and the Organisation for Economic Co-operation and Development estimates that the direct costs of treating safety failures amount to as much as 15% of total public health expenditure.
Although it is too soon to have pan-European data on CAUTI that is directly related to the coronavirus crisis, it is a given that many patients admitted to ICUs are going to be fitted with a urinary catheter when their health deteriorates to the point that they are unable to care for themselves. And that means we have to expect an increase in CAUTI because being fitted with a urinary bypass catheter is a major risk factor in developing HAIs. In fact, the vast majority of urinary tract infections in hospitals are avoidable.
Investment and policy
Increased infections almost inevitably lead to increased use and misuse of antibiotics, which has led to drug-resistant bacteria that represent yet another threat to patient safety. In April, the members of the first European Patient Group on Antimicrobial Resistance issued a Declaration calling upon European policymakers and national governments to commit to a full range of interventions in the field of education, prevention and investment with a view to prevent HAIs and the spread of AMR.
Whether the problem is HAIs or AMR, the solutions often fit into the same broad categories: education and training for doctors, nurses and patients themselves; better integration of health and social care including expanded use of digital solutions beyond the current crisis; and making better use of early diagnosis to make data-based decisions that prevent the vicious circle of infections, diagnostic errors, medication errors and increased use and misuse of antibiotics.
Estimates suggest that each euro spent on measures to tackle AMR alone can save healthcare systems €2.50 —that’s a 150% return on investment!
Towards a greater standard of care
Sadly, the lack of harmonised European guidelines, protocols and processes for ensuring patient safety remains one of the biggest obstacles to achieving it. EU law relegates the European Commission to a supporting role. It can and does encourage and facilitate co-operation and the exchange of best practices, but it is ultimately up to individual EU Member States to embrace and adopt those best practices, including a consistent approach to healthcare workers’ training and continuous education, hospital hygiene standards and adoption of best available technologies across the full spectrum of healthcare services but especially in prevention and early diagnosis.
Even before the COVID-19 pandemic, Europe was experiencing a rising demand for complex care linked with an increase in the percentage of the European population that is elderly and has chronic and multiple diseases. The pandemic has brutally exposed Europe’s lack of a co-ordinated approach to public health, the existing inequalities in the quality of healthcare across the union and the shortage of qualified healthcare workers, especially in emergency rooms and intensive care units.
Health First Europe and like-minded organisations including the European Health Management Association (EHMA) and the European Network for Safer Health Care (ENSH) have published a long list of policy recommendations over the past year including:
- Creating EU curricula for healthcare professionals including for continuous education
- Developing a European framework for consolidating and sharing science-based data regarding adverse events in order to ensure greater comparability and standardisation
- Improving digital literacy and skills for both healthcare professionals and patients;
- Facilitating the systematic exchange of best practices between healthcare providers both at national and European level in order to address the issue of fragmentation in the standards of care and to promote an improved safety culture in all healthcare settings
- Strengthening the role of the ECDC while supporting the development of a European surveillance system for HAIs and AMR
- Prioritising strategic investments in diagnostic tools, automation, innovative solutions and IT systems that balance the up-front costs with the long-term return on investment of such solutions
- Increasing awareness of HAIs and AMR and improving infection prevention and control measures across human health and animal care settings to help prevent infections and the spread of AMR
Will national decision-makers heed the call?
Interim Executive Director
Health First Europe