In December 1999, just before the turn of the new millennium, the Institute of Medicine (IOM) of the National Academies of Sciences released what has become the most read and subsequently quoted report ever to emerge from that advisory body to Congress and the President. What has simply come to be known as the “To Err is Human” report raised eyebrows, not to mention the hackles of many in the healthcare industry by its major conclusion that up to 98,000 Americans die in hospitals every year due to medical errors.
There have been many specific areas of progress in patient safety over the past decade, several of which have been in the area of healthcare-associated infections, particularly those related to catheters (catheter-related bloodstream infections or CRBSI). The University of Pittsburgh Medical Center went from a rate exceeding the national average to virtually eliminating them just by following very strict universal precautions and other sterile techniques. Other major improvements have been those associated with dramatic decreases (up to 80%) in the rates of medication errors through the judicious use of computerized physician order entry (CPOE) and real-time clinical decision support systems.
Hospitals, in collaboration with physicians and nurses, have also decreased the rates of pressure ulcers in patients by up to 70% in New Jersey by following protocols established for turning patients regularly, using special bed surfaces to minimize the effects of gravity and friction, and ensuring proper nutrition in bed-bound, often elderly patients. The whole geriatric medicine movement has had a particular focus in the care of elderly patients to prevent pressure ulcers, as well as falls and other mishaps associated with older patients.
However, most of the significant progress in the patient safety movement noted above has been in the inpatient setting. In a hospital or medical center, there is an organization which can bring to bear institutional resources (people and technologies) working in teams which can produce concerted efforts to set and achieve safety improvement goals in a systematic way.
Due to the lack of these resources in many outpatient and physician office settings, the gains have been much fewer and less dramatic. The major gains in these settings have been confined to improving communications, including handoffs between physicians, nurses, managers and others within the practice - with or without the assistance of electronic medical records or other assistive technologies (please see below for more on this). Moreover, most of the significant – and most publicized – gains in patient safety in the outpatient and medical office setting have been in the larger group practices with access to people, technologies and other resources similar to those found in the larger hospitals and health systems.
While there may be many specific areas of progress in both the inpatient and outpatient areas, the following three broad categories chart the progress in patient safety and are the most relevant to physicians and their affiliated hospitals of those that appear in a recently published Health Affairs article by Robert Wachter, M.D., Professor and Associate Chairman of Medicine and Chief of Hospital Medicine and Medical Services at the University of California Medical Center at San Francisco (UCSF).
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