Is patient safety inadequate?

In its much publicized and discussed 1999 report, “To Err is Human”, the Institute of Medicine (IOM) found that made 44,000 to 98,000 lives a year in the U.S. were lost due to medical errors and, consequently, made patient safety a priority.

Since that time, has patient safety improved?

In their study recently published in The New England Journal of Medicine, Drs. Ashish Jha (Harvard School of Public Health and VA Boston Healthcare System) and David Classen (Computer Sciences Corporation and University of Utah) looked at recent reports and concluded that little to no progress had been made. According to them, “if the United States has made progress in patient safety, it has been inadequate.”

Drs. Jha and Classen recommend, as the title of their article explicit states, “harnessing electronic data for safer care”:

Electronic health records (EHRs) “can systematically measure patient safety, turning a laborious, manually intensive and expensive process of sifting through medical records to identify adverse events into an automated one that is efficient, consistent, and affordable. Although the technology is already available, most EHRs today are not built with this capability in mind—and it won’t be easy (or cheap) to retrofit EHR systems later.

Although IT has been embraced in almost all facets of life in the United States, is IT in healthcare the panacea for improving patient safety?

In its recent report “Health IT and Patient Safety Building Safer Systems for Better Care”, although the IOM acknowledges the need and desire to reduce medical errors, in examining a broad range of health information technologies, including electronic health records, secure patient portals, and health information exchanges (but not software for medical devices), the report found:

Little published evidence exists that quantifies the magnitude of the risk associated with health IT problems, partly because many technology vendors discourage the free exchange of safety-related information in their contracts with health care providers.  But serious errors involving these technologies — including medication dosing errors, failure to detect fatal illnesses, and treatment delays due to poor human-computer interactions or loss of data — have led to several reported patient deaths and injuries.

“Just as the potential benefits of health IT are great, so are the possible harms to patient safety if these technologies are not being properly designed and used,” said Gail L. Warden, president emeritus of Henry Ford Health System and chair of the committee that wrote the report. “To protect patients, industry and government have a shared responsibility to ensure greater transparency, accountability, and reporting of health IT-related medical errors.”

Improving patient safety and health outcomes will take a combination of well-trained and committed healthcare providers using technology in a smart way. The resuscitation of Howard Snitzer is a great example of this. Howard survived 96 minutes without a pulse. Not only is Howard’s story a testament to people’s perseverance (his very determined group of rescuers, who refused to give up) but of the use of technology to aid this effort (their use of capnography to monitor his exhaled breath). For more on his story, please click here.

So, what do you think – has patient safety improved, stayed the same, or gotten worse since 1999?

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