Patient Safety in Hospitals- An Insiders View
The Institute of Medicine which is a very sophisticated scientific medical group, made up of some of the leading physicians in this country, dropped a major bombshell when it reported that thousands of hospital patients die or are harmed by errors made by caregivers. The caregivers are doctors, nurses, pharmacists and countless other unseen people like technologists and secretaries in laboratories, whose work it is to help people not harm them. I have worked in my practice exclusively in a hospital for over thirty years and know that errors are made. Most errors do not result in adverse patient care, the majority are caught before the patient is ever exposed to the potential consequences. Nevertheless, the Institute of Medicine is correct in identifying unintentional mistakes which do and have caused problems. The exact number can be argued and the remedy to this will be argued even more. This certainly is grist for the politicians' mill.
What is Done to Prevent Mistakes?
Patients need to know that there are a series of systems in place to protect patients from human error. Nobody reasons that there is an "acceptable" mistake rate that we can tolerate. All steps in patient care have built-in redundancies and methods to prevents errors. For example, the administration of blood requires two people to check the patient's name, hospital number, blood type and other information before the blood can be given. Syringes and bags that have medicine on them must carry a label with the medicine and concentration of medicine, which must be read before administered and verified as an appropriate medical order. All hospitals have a variety of committees charged with the oversight of patient care and the identification of problems. One example is the infection committee which looks at infection rates and tries to identify practice patters that contribute to increases in hospital infections. In fact there are literally hundreds if not thousands of safeguards to "prevent" errors.
Who Governs the Safety?
Physicians and nurses must be licensed to practice: they are licensed by the state. There are hospital committees which are charged with the responsibility of granting privileges to physicians. Increasingly these committees are voluntarily requiring proof that the physician allowed to practice in a hospital has the experience or training to do the procedures or diagnostic tests applied for and that results are within national norms. Pharmacy and nursing monitor the performance of their personnel and all hospitals have quality improvement programs designed to improve care and to monitor the quality of care. The Joint Commission on Hospital Accreditation inspects hospitals and is especially focused on procedures and systems known to be at risk for human error. Hospitals must report safety violations when they occur, and if they occur with an unacceptable frequency the hospital will lose its accreditation. Finally, the U.S. has a legal system which permits malpractice and other litigation, and this has long been a major deterrent in the fight to eliminate medical errors.
Seabrookers and all other Americans need to have confidence in their hospitals. The aim of all hospitals should be zero tolerance for mistakes. My recommendation is that systems be created within hospitals, if they do not already exist, that report all errors so that accidents and mistakes are tracked and individual hospital specific solutions found where recurrent problems lie. It has been my experience that when problems are identified and supported with data that they can be solved. Those who argue against reporting of errors might have better ways in mind of improving care, but I think good information helps us in the performance of our duties. How much information should be made public is a whole other issue, but patients must know that their doctors, nurses and hospitals are doing everything possible to eliminate errors.