REGINA -- The Provincial Auditor believes critical healthcare incidents are under reported in the province, and that the Saskatchewan Health Authority is submitting critical incident notifications and reports late to the Ministry of Health.

The details of these findings are outlined in the 2021 Auditor report.

IMPROVING PATIENT SAFETY

Reporting of critical incidents between the Ministry of Health and the Saskatchewan Health Authority (SHA) topped the list of recommendations from the auditor.

Critical incidents are described in the auditor report as “a serious adverse health event that did or could have resulted in serious harm or death of a patient.”

The Provincial Auditor Judy Ferguson reported that critical health incidents are not on the decline, with the SHA reporting around 200 incidents annually for the last two years, 91 incidents resulted in death in 2019-20. The audit also found that the Ministry is not encouraging timely reporting of critical incidents.

“The Authority often submitted to the Ministry critical incident notifications and reports late. On average, the Authority took over 100 days to report. Delayed reports result in delays in the Ministry evaluating the robustness of Authority-planned corrective actions, which delays properly addressing contributing factors.”

According to the report, about one-third of critical health incidents in hospitals are preventable.

“The audit found the Ministry does not determine whether it is notified of all critical incidents. Audit analysis suggests underreporting of incidents,” Ferguson said in her report. “For example, between December 2019 and September 2020, the Saskatchewan Health Authority reported to the Ministry 17 critical incidents related to medical devices whereas, for the same period, it reported 24 incidents for medical device failures to Health Canada.”

Saskatchewan healthcare organizations, like the SHA, are legally responsible for reporting critical incidents to the Ministry of Health, and identify and take steps to address their causes.

The audit found that more than two-thirds of corrective actions were not implemented by the SHA.

MENTAL HEALTH AND ADDICTIONS SERVICES

The audit found that the SHA needs to do more to meet demand for mental health services in the Prince Albert area.

Ferguson found that some processes have been improved since the 2018 audit, however more can be done to implement previous recommendations.

Prince Albert and surrounding areas encountered psychiatrist shortages starting in 2017-18.

“While some wait time targets for counselling and psychiatry services were met, others were not.,” Ferguson said in her report. “For example, in 2019-20, more than 90 percent of children with moderate acuity level waited more than the 20-business-day target for their first psychiatrist appointment. This percentage had increased by at least 10 percent since 2017- 18.”

The audit also found that the SHA does not have a strategy in place to collect information on mental health and addiction services sought by patients outside the SHA.

“Working with the Ministry of Health and eHealth on implementing a single electronic health record system with complete client history would help the Authority make necessary client information readily available to healthcare providers across the province,” she said.

Ferguson said the SHA needs to work with the Ministry of Social Services to coordinate housing options with supports for mental health and addictions.

REMAND IN SASKATOON

Ferguson reported the Ministries of Justice, Corrections, Policing and Public Safety need to do more to record whether their strategies are helping to reduce the number of people on short-term remand.

Early Case Resolution, Rapid Remand Response, and Community Alternatives to Remand are the three existing strategies used to reduce the number of individuals on remand in the Saskatoon area.

“By September 2020, they have not decided by how much and by when they expect their various remand strategies to contribute to reducing the number of individuals on remand,” Ferguson said. “In addition, they are not yet measuring and reporting on how quickly, and to what extent their strategies are reducing the number of individuals in short-term remand.”

According to the auditor report, short-term remand is the main contributing factor for an ongoing year-over-year increase in the number of people in custody in Saskatchewan.

Nearly two-thirds of individuals admitted into custody in Saskatchewan were held on remand and more than 40 percent of the annual average individuals in custody in Saskatchewan are on remand.

Ferguson recommends setting measurable targets and collecting key data from external partners, like police services, to help indicate whether these strategies are working.