eMJA: “The lessons of hospital mistakes”

To the Editor: After the recent New South Wales parliamentary inquiry into Royal North Shore Hospital, one might ask whether the deliberations will deliver real change to the hospital system.

An article in the Lancet draws attention to some adverse outcomes in London hospitals.1 One such case is reported from the evidence and conclusions of the Islington Coroners’ Court into the death of a man as a result of his outpatient management. The report states:

The jurors have . . . taken into consideration the large number of patients attending Guy’s Hospital as casual patients, [and] are of the opinion that the skilled supervision is insufficient, and should be increased; but they . . . believe the deceased received all the care and attention which the present arrangement of the hospital affords.

The report goes on to discuss the effect of the excessive numbers of patients each house surgeon is expected to manage daily. The writer is of the mind that “the reported cases are now so frequent that something will have to be done”.

As for immediate solutions, the report suggests:

The officers of hospitals will have to be a little more careful. The committees and governors of hospitals must not impose impracticable quantities of work on one man’s shoulders; they must take steps either to diminish the amount of casual out-patient work, or they must increase the number of competent and qualified persons.

The article concludes that “there is another party in these questions who is not entirely free of blame — viz., the public”. The writer supports the public’s right to “express indignation at defective diagnosis and accommodation in hospitals” but implores the public to be more liberal with hospital funding. The conclusions are straight to the point:

The committees of hospitals cannot multiply beds and qualified house-surgeons without funds, any more than one can make bricks without straw. And if the maimed and the diseased are not to be denied skilled advice and accommodation at hospitals, or are not to be passed from one hospital to another, the public must be far more liberal in its support of hospitals than it has been.

This report was published in the Lancet on 20 August 1881. Has nothing changed?! The public has now relinquished its responsibility for running public hospitals to the state. I hope more permanent solutions to the problem will follow the recent inquiry! As the writer suggested in 1881, “something will have to be done”.