Press release

Has the pace of change in health care hurt patients?

p. 1585  Rates of adverse events among hospital admissions and day surgeries in Ontario from 1992 to 1997 — D. Hunter, N. Bains [full text]

The pace of change in Ontario's health care system accelerated dramatically in the 1990s and Dr. Duncan Hunter and Namrata Bains report that, although changes in Ontario hospitals have not had a substantial impact on the quality of care as measured by adverse events, there has been an increase in the trend in hospital complication rates.

The authors suspect that the cause of the small, yet consistent increase in adverse events lies either with a change in reporting or coding practices, or a decline in the quality of care provided.

p. 1565  Examination for sexual assault: Is the documentation of physical injury associated with the laying of charges? — M.J. McGregor et al [ abstract ]

In the first study to link medical findings in Canadian sexual assault cases to legal outcomes, Margaret McGregor and colleagues reviewed the charts of 95 sexual assault cases that had been examined by the BC Women's Sexual Assault Service in 1992 and for which a police report had been filed. They found that charges were more likely to be laid in cases with documented moderate to severe injury than in cases with mild or no physical injury.

The authors add that since there is always a tension between the time required to "debrief" the patient and that required to provide supportive counseling, treat the effects of the assault, and to meticulously collect and document evidence, good evidence that the time spent on the forensic part of the examination does influence the legal outcome of the case is important. The authors suggest that it would be valuable to extend this line of research to learn more about the other variables that predict the laying of charges and, even more important, the securing of a conviction.

p. 1573  Non-heart-beating organ donors as a source of kidneys for transplantation: a chart review — G.M.D. Campbell, F.R. Sutherland [full text / abstract]

p. 1590  Death provides renewed life for some, but ethical hazards for transplant teams — J.B. Dossetor [full text]

While organ transplantation is the treatment of choice for patients with end-stage organ failure, the supply of organs has never been able to keep pace with the demand. As Canada continues to search for possible solutions to the shortage of vital organs, the possibility that getting permission to use organs from those who have died from irreversible cardiopulmonary arrest — now termed non-heart-beating death — has emerged as another potential way to increase the number of organs available for transplantation.

Graham Campbell and Francis Sutherland studied the charts of 209 patients who died in 1995 in either the emergency department or intensive care unit of the Foothills Hospital in Calgary. They found that there might have been 10 additional donors, which would have increased the supply of cadaveric kidneys for transplantation by 48%.

In an accompanying editorial, John Dossetor provides ethical guidance in the wake of continued debate surrounding the definition of brain death.

p. 1557  End-stage renal disease in Canada: prevalence projections to 2005 — D.E. Schaubel et al [full text / abstract]

p. 1589  Treating end-stage renal failure in the next millenium — T.A. Hutchinson [full text]

Before the invention of dialysis in the 1940s, the average survival of patients with chronic kidney failure was approximately 2 weeks. With the current use of dialysis and transplantation average survival has jumped to about 5 years. While this improvement is a dramatic achievement, it also has major implications for the health care system as the costs of treating patients with end-stage kidney failure rise with the increased prevalence of the disease.

Douglas Schaubel and colleagues examined data from the period between 1981 and 1996 and predict the number of Canadians receiving renal replacement therapy will almost double to 32 952 by the end of 2005. In 1996 17 807 were receiving such therapy. These projections suggest that Canada will face a growing shortage of resources to accommodate patients with end-stage renal disease.

In an accompanying editorial, Tom Hutchinson explains that the projected increases in prevalence are a testament to lives that medical advances have saved and suggests humane ways to cope with this success.