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At the time of publication of this editorial, it will have been almost exactly 10 years since Carmen Lawrence, then Federal Minister for Health, prematurely released the results of the Quality in Australian Health Care Study (QAHCS) in Federal Parliament on 1 June 1995(1). This study has engendered considerable interest and comment, as reflected by the fact that the formal publication of the results, in the Medical Journal of Australia some months later2, already ranks amongst its 10 most cited papers in its 90 year existence3.
The frequency with which patients in Australia were being harmed by health care surprised everyone, including the investigators. Of particular concern was the fact that an ostensibly identical study, also on 15,000 admissions in 1992, but of American rather than Australian medical records, showed that the rate of iatrogenic harm was five times greater in Australia (16.6%)2 than the U.S.A. (3.4%)4. However, a reanalysis of the data from both studies carried out by the Harvard School of Public Health and the Australian Patient Safety Foundation (APSF), showed that the rates for both countries are most likely around the 10 to 12% mark5,6, a rate confirmed now in several other countries7-10.
The medical profession was understandably angry 10 years ago when it was "ambushed" by the results of QAHCS study, when few even knew it was being carried out. Virtually the only specialty which received positive acclaim was anaesthesia11. Nearly half of the adverse events (48%) were attributed to surgery, whereas anaesthesia was implicated in only 2%, and these were associated with less disability, no deaths and fewer additional days in hospital (3 versus 7).
That anaesthetists in Australia should have emerged so well is perhaps not surprising. Anaesthetists worldwide have been involved in systematic studies of iatrogenic harm, with a view to its prevention, since the first Hyderabad Chloroform Commission in 1888(12). Australia was the first country in the world to collect and study all anaesthetic deaths on an ongoing basis, starting with the New South Wales Ministerial Committee for investigating anaesthesiarelated deaths in 1960(13). Australia was also the first country to set up a national anaesthesia incident monitoring system (AIMS) in 1988(14). The Australian and New Zealand College of Anaesthetists has effectively set national standards for many...