Health board high on adverse events list

The Southern District Health Board still has the third highest number of reported adverse events in New Zealand despite a slight decline in the past year.

There were 53 adverse events reported by the Southern District Health Board for 2016 - 2017 down from 62 last year.

Only the Auckland (95) and Canterbury (73) DHBs had a higher number of reported events.

The figures were released as part of the Health Quality & Safety Commisson's report learning from adverse events report.

Eye patients adversely affected by delays in follow up appointments and treatment are expected to feature in the Southern DHB's 53 cases.

In the report, the Southern DHB provided an update on the the issues with its ophthalmology service saying there had been a significant reduction in the 4618 patients identified as overdue for follow a up appointment in October last year.

As part of a review into the service the health board had increased its capacity, introduced changes to it's model of care and improved its reporting systems.

Specialist training had also been offered to nurses.

Southern DHB chief medical officer Dr Nigel Millar said the delays in treatment were unacceptable and the health board apologised for its failure to deliver the care patients were entitled to.

While the number of events reported was lower than the previous year, the numbers were known to fluctuate significantly and no conclusions could be drawn from the change, Dr Millar said. 

Nationally there were 542 adverse events reported by district health boards and 86 by other health providers, such as ambulance services.

Clinical management events, a category which includes delays in diagnosis and treatment, were the most reported events with 282 cases nationally.

Serious injuries from a fall were the second most reported events, with 210 cases last year, including 77 patients who suffered a fractured neck or femur as result of a fall.

Commission chairman Prof Alan Merry said the report reflected a steady improvement in reporting culture and transparency.

The report recommended consumers were put at the centre when reporting, reviewing and learning from adverse events.

Prof Merry said research showed those who had been affected by an adverse event offered a unique perspective on the event.

"Consumers may be able to perceive care transition and process issues, including service quality, that occur before, during and after adverse events, that are less likely to be identified by providers.''

Read more in tomorrow's Otago Daily Times

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