Slow Gains in Hospital Patient Safety

Pick Up the Pace, Researchers Say

Medically Reviewed by Louise Chang, MD on December 13, 2005
From the WebMD Archives

Dec. 13, 2005 -- The latest report card on patient safety at American hospitals boils down to this: getting better but needs faster improvement.

"Efforts for improvement must be accelerated," states a report in The Journal of the American Medical Association.

Systems that protect hospital patients aren't up to speed, note Daniel Longo, ScD, and colleagues.

"Data are consistent with recent reports that patient safety system progress is slow and is a cause for great concern," they write.

Of course, millions of people use U.S. hospitals with no problems.

Safer Systems Needed

Longo works at the University of Missouri-Columbia's medical school in the department of family and community medicine.

His team sent surveys to all acute-care hospitals in Missouri and Utah in 2002 and again in 2004. The goal was to look for system changes that occurred over the period. More than three out of four of the hospitals responded (126 hospitals in 2002 and 128 in 2004).

The surveys included 91 questions. Topics included hospital policies on investigating medical errors, storing and administering drugs, and using computers to record doctors' orders.

Slow Improvement

The results were generally better than in 1998, when hospital policies on patient safety were sharply criticized in a report by the Institute of Medicine (IOM).

The IOM is a nonprofit group started in 1970 as a branch of the National Academy of Sciences.

But even in 2004, the hospitals still were "not close" to the goals set by the IOM in 1998, write Longo and colleagues.

Safety Check

Almost three-quarters of the hospitals (74%) reported fully implementing a written plan on patient safety. But nearly one in 10 hospitals (9%) admitted to not having a written plan for patient safety.

Also, only 3% of the hospitals surveyed in 2004 reported full implementation of computer systems tracking medications ordered by doctors for patients.

Surgery was the area that appeared to have the greatest level of systems for patient safety, write the researchers.

The safe use and storage of medications also improved. The improvement wasn't dramatic, since many hospitals had already improved their medication safety policies by 2000.

The researchers took the hospitals at their word. The hospitals' claims about their patient safety systems weren't confirmed. No major differences were seen between urban and rural hospitals.

Building Better Systems

"Tell me how you will measure me, and I will tell you how I will behave," states a journal editorial.

The editorialists -- who include Stephen Parker, MD, of Tufts-New England Medical Center -- took that phrase from the theory of constraints, which started in the field of manufacturing. It can be applied in situations where constraints exist.

Parker's team didn't work on Longo's study. They note that Longo provided data on the introduction of safety systems but better measurements and data are needed to track patient safety.

"Improving the safety of patient care must be a high priority for all clinicians and administrators," write Parker and colleagues. "It must become a central part of their training."

"Rewarding safety will surely help," they add. "The time has come to take bold action and to embrace change, but first it is time to understand the constraints to accomplishing that change."

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SOURCES: Longo, D. The Journal of the American Medical Association, Dec. 14, 2005; vol 294: pp 2858-2865. Parker, S. The Journal of the American Medical Association, Dec. 14, 2005; vol 294: pp 2906-2908. News release, JAMA/Archives.
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