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Posted December 8, 2004

Patient Safety: Hospitals – Safe by Design
Keeping patients safe has always been a key hospital mission. Making sure patients receive the care they need while guarding against infections or other injuries is standard procedure at America’s hospitals. Safety is literally designed into hospital care.

The care processes at hospitals are carefully designed to promote patient well-being and to reduce opportunities for error and injury. Because today’s medical care is complex and constantly advancing, so are the steps hospitals take to ensure patient safety.

Hospital teams of doctors and nurses draw on the latest medical research to develop detailed safety procedures. Safety plans are in place for everything from simple tasks, such as taking patients’ temperatures, all the way up to the most complex procedures and services, such as organ transplants and neurosurgery. Safety is designed into every hospital process.

Studies at hospitals all across America show that when doctors and other health care workers carefully learn and follow these plans, the number of accidental injuries and infections goes down. Among safety improvements many hospitals have made in recent years:

• Dispensing potentially harmful drugs from hospital pharmacies only in the amount and strength required for a single dose. This has reduced the danger of overdoses due to staff accidentally drawing incorrect or undiluted doses of certain powerful drugs at the bedside.
• Physicians increasingly ordering medicines, tests and treatments directly on hospital computers. This allows computer systems to alert doctors to potentially dangerous drug combinations or other hazards, reducing the chance of errors due to incorrectly relaying verbal or mis-reading hand-written orders. In facilities without such technology, staff increasingly utilize a number of manual processes to achieve similar end results.
• Nurses and other hospital workers double-checking patient identities before delivering medicines or blood products. This keeps patients from accidentally receiving care intended for someone else.

As safe as hospital care is, doctors, nurses and others are always on the lookout for ways to cut risks even more. Hospital care and safety processes are constantly being re-examined and refined to take advantage of emerging technology, scientific knowledge and innovative new procedures resulting from clinical studies.

When a patient is injured or a preventable infection occurs, teams of doctors, nurses and managers take a close look at the situation, building upon every opportunity to continually enhance patient care. They look for ways that hospital procedures can be changed to prevent similar events or injuries from being repeated.

Not only is hospital care designed to be safe, hospitals themselves are designed to constantly improve safety processes. The result is safe and reliable care for patients – and a safe environment for hospital visitors and staff.  

Over the last few years, a wide range of health care, government, business and consumer groups have increased their support of hospital efforts to promote patient safety. These diverse organizations are cooperating with hospitals to enhance patient safety and to develop ways to reduce the chances of patients being injured. They include:

Agency for Healthcare Research and Quality (AHRQ), a unit of the U.S. Dept. of Health and Human Services

• Established a national Patient Safety Task Force that coordinates data collection and research on medical errors.
• Funds many demonstration projects to develop systems that can reduce medical errors.
• Helps establish standards for information systems and data collection so that safety performance can be measured and improved.

National Quality Forum (NQF), a coalition of hospitals, physicians, health care purchasers and insurers

• Developed a list of 30 high-priority safety practices to be implemented by hospitals and other health care providers. This list forms the basis for incident reporting systems that have begun operating.

Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the American Osteopathic Association Healthcare Facilities Accreditation Program (HFAP), national organizations that certify most hospitals for Medicare participation and state licensing, have adopted national patient safety improvement goals for all hospitals

• Surgeons mark the site of surgery before operating.
• Nurses or others who receive orders verbally read them back before carrying them out.
• Patient identity is verified using two sources before administering medications or blood products.

Leapfrog Group, a business coalition dedicated to improving health system safety and quality

• Monitors hospital use of key patient safety technologies and practices, such as the use of computerized physician order entry systems.
• Publishes information on hospital safety practices to guide health care choices.
  

There is evidence that focusing on reporting and improving systems reduces errors and enhances care. Many recent studies at individual hospitals have shown that improving processes for things like ordering and delivering drugs sharply reduces medication errors, the most common health care error.

For years these kinds of improvements were carried out by hospitals with the assistance of quality improvement and quality assurance committees. In addition, now most hospitals also have teams that focus specifically on improving patient safety systems.

One goal of patient safety teams is to create a “culture of safety” in hospitals in which workers feel comfortable reporting errors or “near misses” that might have been overlooked in the past. This helps improve processes to prevent future errors.

The Agency for Healthcare Research and Quality has recently released a new survey to help hospitals evaluate their progress in creating a culture of safety. It helps hospitals to assess employees’ attitudes about patient safety, teamwork within and across units, openness of communication, response to errors and other key components of a culture of safety. Legislation that would encourage error reporting by guaranteeing that the process remains confidential passed both houses of Congress in 2004, but did not become law. Similar measures are likely in the next Congress.

Public interest in patient safety was heightened by a 1999 report of the Institute of Medicine (IOM) that estimated medical errors may result in 44,000 or more deaths annually. While this figure represents a very small fraction of the more than one billion medical visits annually in the United States , every effort is being made to reduce these numbers.

With national support for creating safer medical processes, gathering data, and identifying and implementing best safety practices, the incidence of health care errors can be reduced by 50% or more within five years, according to the AHRQ.

The key is building on the solid foundation of quality and safety improvement already in place in America ’s hospitals.

> Continue to Patient Safety Fact Sheet