Support for chiropractor reporting

CALLS for a chiropractic adverse events reporting system to be established in Australia has received strong support, with experts saying such a system would bring chiropractors in to line with other health professionals.

In a letter published in the MJA, Mr John Cunningham, an orthopaedic spinal surgeon, and co-authors said adverse events reporting systems were crucial for maintaining quality and safety in health care. (1)

“Such systems ensure that adverse events are reviewed, thus identifying root causes of error, minimising risk of recurrence, ensuring professional accountability and improving patient care”, they wrote.

“The chiropractic profession is no more immune to error than any other. A chiropractic adverse events reporting system would bring chiropractors in line with other Australian health professionals and fulfil public entitlement to safe, high-quality care.”

Dr Laurie Tassell, president of the Chiropractors’ Association of Australia (CAA), said his association was working towards implementing an adverse events reporting system.

“CAA has recognised the fact that we don’t have an adverse events reporting system and we are examining … what’s the best way to institute one”, Dr Tassell told MJA InSight.

“It is a costly exercise and there are several models so we are in the process of doing our due diligence on which is the best system to use.”

He said the association was looking at systems used internationally and by other Australian health professionals to find the best process for the chiropractic profession and that satisfied “the public interest test”.

While Dr Tassell said the establishment of such a system was important to ensure quality control, he believed adverse events were uncommon in chiropractic.

“The three main objective measures of whether there are adverse events — registration, insurance and literature — all would indicate that there are only a small number of adverse events for the chiropractic profession”, he said.

Dr Tassell said Australia’s main insurer for chiropractors, Guild Insurance, had decreased its professional indemnity rates for chiropractors “very dramatically” over 2 successive years.

The MJA letter came in the wake of controversy surrounding a complaint to the Australian Health Practitioner Regulation Agency that chiropractic treatment had fractured a 4-month-old baby’s neck. It was later reported that the chiropractor had been cleared. (2)

Professor Debora Picone, CEO of the Australian Commission on Safety and Quality in Health Care, said adverse events reporting systems were a critical component of quality care.

“As a very bare minimum, every clinical group involved in patient care should have an adverse reporting system for events that lead to patient harm, so they should be able to record that, know what they are, go back and investigate them and give a very thorough explanation to the patients”, she said.

Professor Picone said the commission had recently released an updated version of its Australian Open Disclosure Framework, which had been endorsed by most of the major clinical societies and by state and territory health ministers. She said adoption of this framework would ensure that adverse events were appropriately detected and communicated to patients. (3)

She suggested the chiropractic profession look to Australian general practice, which was leading the world in terms of clinical professionalism with initiatives such as the Bettering the Evaluation and Care of Health program and the RACGP’s Open Disclosure policy.

Dr Philip Donato, chair of the Chiropractic Board of Australia, said section 3.11 of the board’s code of conduct endorsed open disclosure as good practice. (4)

He said the board was “very supportive” of establishing an adverse events register, even though serious adverse events from manipulation by a range of health practitioners were reported to be rare.

“In general, adverse disclosure registers have been established successfully in public health institutions (such as hospitals) and have significant value. It has been more difficult to establish them to private practice, which is how most chiropractors in Australia work”, he said.

“In any voluntary system, it is difficult to ensure there is robust reporting of adverse events related to manual therapy across the health professions.”

1. MJA 2013; 200: 204
2. The Australian 2013; Chiropractor cleared over ‘break’
3. ACSQHC 2014; Implementing the Australian Open Disclosure Framework in small practices
4. Chiropractic Board of Aust: Code of conduct