We were not previously aware of the work done by Richard Ogilvie and John Ruedy,1,2 and we are grateful to them for bringing this research to our attention. We acknowledge that systematically tracking complications is not a new idea; it dates back at least as far as Ernest Codman's “end results” concept in the early 1900s.3,4
Ogilvie and Ruedy's earlier study has 2 important implications. The first relates to the difference in risk of in-hospital “adverse reactions” between their study and ours: this risk was 24% among medical patients in 1965/66 but only 6% in our study5 and approximately 7% in the Canadian Adverse Events Study.6 Although this discrepancy could be due to differences in study methods, it might also relate to improvements in health care safety in Canada. This observation challenges the popular notion that health care is in a “crisis.”7
The second point relates to the method of detecting adverse reactions. The earlier study was based on voluntary reporting by physicians and nurses. Experience at our institution and elsewhere8 has shown that incident reporting tools usually capture minor, clinically insignificant events while missing serious outcomes. Therefore, it would be interesting to study and implement the strategies that Ogilvie and Ruedy used in their study to encourage health care workers to report adverse events.
Neil Johnson and Myrella Roy point out the need for integrated pharmacy information systems. We agree that this is an important step toward improving the safety of outpatient prescribing. As recently noted by Tamblyn and colleagues,9 patients often have prescriptions from multiple physicians filled at multiple pharmacies. These authors found that a computer intervention that provided prescription information along with some basic decision support significantly decreased inappropriate prescribing.
Alan J. Forster Carl van Walraven Ottawa Health Research Institute The Ottawa Hospital Ottawa, Ont.
Footnotes
Competing interests: None declared.
References
- 1.Ogilvie RI, Ruedy J. Adverse drug reactions during hospitalization. CMAJ 1967;97(24):1450-7. [PMC free article] [PubMed]
- 2.Ogilvie RI, Ruedy J. Adverse reactions during hospitalization. CMAJ 1967;97(24):1445-50. [PMC free article] [PubMed]
- 3.Codman EA. The product of a hospital. Surg Gyn Obstetr 1914;18:491-6.
- 4.Spiegelhalter DJ. Surgical audit: statistical lessons from Nightingale and Codman. J R Stat Soc 1999;162(1):45-58.
- 5.Forster AJ, Asmis TR, Clark HD, Al Saied G, Code CC, Caughey SC, et al. Ottawa Hospital Patient Safety Study: incidence and timing of adverse events in patients admitted to a Canadian teaching hospital. CMAJ 2004;170(8):1235-40. [DOI] [PMC free article] [PubMed]
- 6.Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, et al. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ 2004; 170 (11):1678-86. [DOI] [PMC free article] [PubMed]
- 7.Egan K. Hospital drug errors a “silent epidemic.” Ottawa Citizen 2002 Oct 9.
- 8.Cullen DJ, Bates DW, Small SD, Cooper JB, Nemeskal AR, Leape LL. The incident reporting system does not detect adverse drug events: a problem for quality improvement. Jt Comm J Qual Improv 1995;21(10):541-8. [DOI] [PubMed]
- 9.Tamblyn R, Huang A, Perreault R, Jacques A, Roy D, Hanley J, et al. The medical office of the 21st century (MOXXI): effectiveness of computerized decision-making support in reducing inappropriate prescribing in primary care. CMAJ 2003; 169(6):549-56. [PMC free article] [PubMed]