In spite of an AE being less damaging in PC, large numbers of patients and professionals suffer their consequences each year. An awareness of the magnitude and impact of AE is the first step on the road to the cultural change necessary for achieving safer healthcare.
The incidence of adverse events reported by patients was similar to that estimated by other procedures. The patient's concept of adverse events was different from that of the physician. The quality of communication from the physician influenced the patient's perception of adverse events, and the majority wanted adverse events to be disclosed. Patients emphasised emotional consequences of the adverse events. The majority supported system modifications to prevent adverse events and to sanction the physicians when an adverse event occurs.
The true risk resides in the number of exposures to potentially iatrogenic actions, rather than being intrinsic to age or the presence of certain comorbidities.
The increasingly complex health care systems, together with more vulnerable, highly informed and demanding patients, conform a clinical environment in where adverse effects (AE) related to health care practice appear. The incidence of AE in hospitalized patients has been estimated between a 4 and a 17%. Twenty-five per cent of them were serious and half were considered avoidable. Seventy per cent of the AE are due to technical failures, faults in the decision making process, inappropriate performance based on the available information, problems in the anamnesis, and absent or inadequate health care provision. The explanatory model of the causal chain of an adverse effect supports that systems failures are more important than people failures. The IDEA Project seeks to study the incidence of AE related to health care for the first time in Spain. To facilitate the necessary change from a punitive culture to a proactive culture, a multidisciplinary approach of the problem taking into account the point of view of health professionals, patients, community leaders and courts is needed.
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