What would prompt that? This New York Times article, citing a forthcoming NEJM study about medical errors in North Carolina. Here's the lede:
Efforts to make safer for patients are falling short, researchers report in the first large study in a decade to analyze harm from medical care and to track it over time.
The study, conducted from 2002 to 2007 in 10 North Carolina hospitals, found that harm to patients was common and that the number of incidents did not decrease over time. The most common problems were complications from procedures or drugs and hospital-acquired infections.
Other excerpts:Dr. Landrigan’s team focused on North Carolina because its hospitals, compared with those in most states, have been more involved in programs to improve patient safety.
But instead of improvements, the researchers found a high rate of problems.. . . The findings were a disappointment but not a surprise, Dr. Landrigan said. Many of the problems were caused by the hospitals’ failure to use measures that had been proved to avert mistakes and to prevent infections from devices like urinary catheters, ventilators and lines inserted into veins and arteries.
And another:
Dr. [Bob] Wachter said the study made clear the difficulty in improving patients’ safety.
“Process changes, like a new computer system or the use of a checklist, may help a bit,” he said, “but if they are not embedded in a system in which the providers are engaged in safety efforts, educated about how to identify safety hazards and fix them, and have a culture of strong communication and teamwork, progress may be painfully slow.”
Exactly right, Bob! What does it take to motivate this profession? What does it take to make process improvement part of medical school and residency training programs.Painfully slow, and painful or worse to patients.
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Addendum: Dr. Wachter also discusses this study on his blog, here.
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