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Challenge Accepted AKU FACULTY, ALUMNI, AND STAFF JOIN HANDS TO LEAD A UNIQUE INITIATIVE FOR LARGE-SCALE NATIONAL IMPACT: The Centre for patient safety.

Doing the right thing, each and every time, for every patient.

"I was quite surprised to know that something as simple as misreading, misspelling or miscommunication can result in a terrible medical error. These errors can easily be avoided.” - Student, MBBS Class of 2023

Every human’s wellbeing rests in their health. When one’s health deteriorates and professional care is required, people often go to a hospital with complete trust in their attending medical professional’s caregiving abilities. After all, physicians do swear by an oath to “do no harm”.

It may be surprising for people to learn that many hospitalisations result from injury or harm caused by erroneous medical care, and not from an underlying medical condition that a patient was seeking treatment for. In fact, 25-50 percent of all medical errors that incur loss of life or permanent disability, are entirely preventable (Makary MA, Daniel M. Medical error—the third leading cause of death in the US. BMJ. 2016 May 3;i2139).

Beyond the grave cost of physical harm caused, such errors give rise to costs that run into tens of billions of dollars (OECD, 2020). Root causes can be traced to miscommunication, the overuse and misuse and underuse of healthcare resources, and a grave absence of health literacy and adequate training. Prevalence of preventable harm in medical institutions is rampant, worldwide.

Case Study

"A 56-year-old woman with a history of persistent asthma presented to the emergency department (ED) with shortness of breath and chest tightness that was relieved with Albuterol. She was admitted to the hospital for acute asthma exacerbation. Given a recent history of mobility limitation and continued clinical decompensation, a computed tomography (CT) angiogram of the chest was obtained to rule out pulmonary embolism (PE). The radiologist summarized his initial impression by telephone to the primary team but the critical finding (“profound evidence of right heart strain") was not conveyed to the primary team. The written radiology impression was not reviewed, nor did the care team independently review the CT images. The team considered her to be low-risk and initiated therapy with a direct oral anticoagulant (DOAC). Later that day, the patient became hemodynamically unstable and was transferred to the intensive care unit (ICU). She developed signs of stroke and required ongoing resuscitation overnight before being transitioned to comfort care where she died."

David Barnes, MD and William Ken McCallum, MD, (2021), Agency for Healthcare Research and Quality

These errors create a heavy financial and human burden for low-and-middle-income-countries (LMICs), including Pakistan, to bear. Unfortunately, LMICs in South Asia have conducted minimal reliable research in this field and therefor there is limited data available for medical professionals to learn from.

"In developing countries like Pakistan, we are focusing more on disease-based care rather than holistic health system-based care. A local centre to look at our unique set of problems and help develop locally relevant solutions is the need of our country." - Dr Asad Latif, Director, Centre for Patient Safety

April, 2019: A nine-month-old girl and her twin sister were brought to the hospital by their father to receive treatment for diarrhoea. Tragically, the nine-month-old was wrongly administered three different injections which led to her health deteriorating severely; her brain was severely damaged, and she was left paralysed. Within days the baby passed away in the hospital’s intensive care unit (ICU) due to what her father describes as negligence from untrained medical staff.

A case from a hospital in Karachi, Pakistan.

A global emphasis on improving the safety of patients has given rise to developments in the science of quality improvement, commonly regarded as the field of Quality and Patient Safety (QPS). QPS is recognised as a main driver in strengthening healthcare systems within the developing world. Hitherto, the Centre for Patient Safety (CPS) at the Aga Khan University was established in 2020.

A team of experts at CPS

CPS is a multi-disciplinary research, teaching, learning and advocacy centre based in the heart of the Medical College in CITRIC, the College's Clinical and Translational Research Incubator. The centre investigates conditions affecting patient care and will promote systemic patient safety within AKU and on a national scale. This team of experts is working to identify medical errors and subsequently develop and implement strategies to prevent such errors.

“I think a centre like this is the first drop in a much bigger wave that is needed” - Dr Fozia Asif, Senior Manager CPS.
Core Team Members (pictured left to right): Dr Asad Latif (Director), Dr Hasnain Zafar (Chief Quality & Patient Safety Officer), Dr Asim Bilgaumi (Chief Medical Officer), Dr Fozia Asif (Senior Manager), Dr Salma Jaffer (Chief Nursing Officer).

Centre for Patient Safety's Goals

  1. To help eliminate preventable harm and improve clinical outcomes for patients at AKU, and ultimately in healthcare systems across LMICs.
  2. To serve as a local, regional and global leader in developing and spreading knowledge related to improving healthcare quality and delivery within Pakistan and other LMICs, and across South Asia (a region for which currently, there is little-to-no data available).
Islamabad: Global Patient Safety collaborative one-day capacity building workshop with WHO, Imperial College London and Government of Pakistan.

Research

The Centre received its seed funding from the MBBS Class of 1993, spearheaded by representative Dr Adnan Bhutta. As a logical first step to begin achieving the Centre’s expansive mission, the CPS team collected and analysed data to gain a detailed understanding of QPS in LMICs. The Centre also plans to develop contextually relevant mixed-methods assessment approach for estimating preventable harm at AKUH. The CPS team works on eight core projects, listed below.

The team at CPS has already developed a QPS module, the first of its kind in Pakistan, for undergraduate nursing students and medical students at AKU. The course has proven to be an eye-opener for many, and is a foundational step in ensuring that AKU graduates practice at a higher standard when caring for patients. This module has the potential to have far-reaching impact on the country’s health sector through provision of enhanced training to medical practitioners, thus giving rise to improvement in healthcare service delivery through QPS on a national-level.

Patient Safety workshop with 4th year BScN students from AKU's School of Nursing and Midwifery, SONAM.

Signifying their rapid success, CPS has received its first external funding by securing a WHO grant. Working with the Department for Community Health Sciences, CPS aims to conduct a comprehensive assessment of patient safety problems at six identified hospitals across Pakistan and to train personnel from the identified hospitals.

Projects underway at CPS

  1. Assessment of the knowledge of healthcare providers in identifying issues pertaining to Patient Safety and Quality Improvement
  2. Perioperative morbidity and mortality assessment at a tertiary care hospital in a low-middle income country
  3. Patients’ experiences of an adverse event during health service delivery and practices in Pakistan
  4. Incidence of adverse events in healthcare of Pakistan
  5. Measuring the patient safety culture at a tertiary care hospital in Pakistan using the hospital survey on patient safety culture
  6. Frequency of patients’ contact with PPE worn by health care workers and visitors
  7. End of life decisions in ICU patients in Pakistan
  8. Scoping review; trigger tool for identification of adverse events

With an incredible team of experts, the Centre for Patient Safety is set to create massive waves of positive change for multiple stakeholders ranging from the government to citizens. In its debut phase, the centre has already secured over PKR 17,250,000 for its research activities, including support from WHO.

CPS seeks to have a profound effect on the culture of healthcare delivery and the health outcomes of patients in Pakistan and in other LMICs. AKU’s faculty, students and staff stand to greatly benefit from new opportunities and trainings that will most definitely enrich their QPS knowledge and capabilities.

"CPS’s undergraduate module was an eye-opener to all possible medical errors that can occur. It made me think about the time my grandfather was admitted in hospital and at multiple points I felt healthcare delivery could have been better. I'd keep QPS as a top concern while practicing medicine myself" - Student, MBBS Class of 2023

Contact the Centre for Patient Safety:

CPS Website │ Email: patient.safety@aku.edu