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Slow Progress in Boosting U.S. Patient Safety

Report suggests many systems need major overhauls

TUESDAY, Dec. 13, 2005 (HealthDay News) -- Although there have been some gains in the area of patient safety, there's still plenty of room for improvement, a new study finds.

And experts reporting in the Dec. 14 issue of the Journal of the American Medical Association say that to make those improvements, the United States is going to need to overhaul whole systems.

"Medicine has been, until recently, a cottage industry where everyone did their own thing and there were no integrated systems to tie it all together," explained Dr. Stephen G. Pauker, author of an accompanying editorial in the journal and associate physician-in-chief at Tufts-New England Medical Center in Boston.

"We're beginning to understand that we have to build the systems," he said. "Safety is not the responsibility of any one individual. It is the responsibility of everyone and of people who design health-care systems. If you don't design safe systems, you lose."

In 1998, the U.S. Institute of Medicine (IOM) published a landmark report called To Err Is Human: Building a Safer Health System, which identified a range of patient safety problems and called for improvements.

According to that report, "at least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that could have been prevented."

Since then, the spotlight has been on patient safety, or lack thereof. A study published in May found that in-hospital computerized medication entry systems in hospitals aren't catching the errors people had hoped they would. In fact, one report published this month in Pediatrics actually found an increase in patient mortality after a computer order entry system was installed in the pediatric section of a hospital.

"That study says if you don't do it right, you can cause trouble," Pauker said.

The current study uncovers more evidence that progress is too slow in coming.

"The IOM report was very, very strong on saying that there needed to be substantial improvement in the quality of healthcare delivered to Americans," said study author Daniel Longo, a professor of family and community medicine and of journalism at the University of Missouri-Columbia. "If [medical errors] were a cause of death, this would be the eighth leading cause."

Longo and his co-authors assessed hospital patient safety systems since the release of the IOM report, specifically identifying changes made from 2002 to 2004 in two states that collaborated on a patient safety project funded by the Agency for Healthcare Research and Quality.

The study included a survey of all acute-care hospitals in Missouri and Utah in 2002 and in 2004, using a 91-item questionnaire. A total of 107 hospitals in both states completed the questionnaires at both points in time.

Seven categories represented the most important patient safety issues: computerized physician order entry systems, computerized test results, and assessments of adverse events; specific patient safety policies; use of data in patient safety programs; drug storage, administration and safety procedures; manner of handling adverse event/error reporting; prevention policies; and root cause analysis.

Progress in patient safety has been "at best modest," the authors wrote.

Almost three-quarters (74 percent) of hospitals reported a full implementation of a written patient safety plan, while almost 9 percent reported no plan at all.

Surgery seemed to have the most patient safety systems in place. Medication showed some improvement, but it had been relatively robust to begin with. Only 3 percent of hospitals reported full implementation of computerized physician order entry systems for medications by the time of the second survey.

According to the authors, the findings point directly to a need for more work.

"There needs to be a national priority on patient safety," Longo said. "Errors cost the economy $8 to $15 billion each year, so this is a major issue from a national perspective. There needs to be prioritization. This is not a splatter gun approach."

"It's also a local issue," he continued. "Medical errors cost $5 million to the hospital itself."

Longo urged individual institutions to conduct their own surveys to identify needed patient safety improvements.

More attention also needs to be paid to people with chronic illnesses, especially those with multiple chronic illnesses, he added.

"We're talking about people's lives. We're talking about money," Longo said. "We have some of the finest hospitals in the world. People from all over the world come here, but we also have some serious problems that we cannot stick our heads in the sand about."

More information

The Institute of Medicine report can be viewed online.

SOURCES: Daniel R. Longo, Sc.D., professor, family and community medicine and of journalism, University of Missouri-Columbia; Stephen G. Pauker, M.D., associate physician-in-chief, Tufts-New England Medical Center and professor, medicine, Tufts University School of Medicine, Boston; Dec. 14, 2005, Journal of the American Medical Association
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