BETHESDA, MD – A decade after the release of the widely read Institute of Medicine patient safety report "To Err Is Human," one expert grades current hospital safety efforts at B-.
"To Err is Human," released 10 years ago on Dec. 1, shed light on how errors in hospitals are responsible for 44,000 patient deaths a year. Experts say the report was responsible for launching the modern patient safety movement.
In his latest report, Robert Wachter, author of two books on patient safety and editor of the federal government's two leading safety Web sites, gives current hospital safety efforts an overall grade of B-, a slight improvement from his grade of C+ five years ago.
Wachter's "Patient Safety at Ten: Unmistakable Progress, Troubling Gaps," published in the December issue of Health Affairs, found overall progress in responses to pressures such as accreditation, regulation and error reporting, but indicated healthcare information technology has lagged behind, with research in the area advancing, though underfunded.
Wachter, a professor and associate chairman in the Department of Medicine at the University of California, San Francisco, graded such aspects of patient safety as hospital regulation/accreditation/reporting systems, healthcare IT, malpractice system and accountability, workforce and training issues, research, patient engagement and involvement, provider organization leadership engagement, national and international organizational interventions and payment system interventions.
The highest grade he gave was an A- in the area of organizational interventions, which Wachter attributes to stronger government intervention over the past 10 years.
Wachter gave several areas grades of C+, including healthcare IT, which was graded in 2004 at B-, and where Wachter sees an almost static situation and "increasing evidence of health IT-related safety hazards and implementation challenges."
With funds directed toward healthcare IT through the federal stimulus package, Wachter said he anticipates improvements in this area.
Wachter cites several early missteps in the patient safety field, including the implementation of residency duty-hour reductions without an attempt to improve procedures when residents sign out; and the national requirement to implement medication reconciliation in the absence of clear guidelines regarding how to accomplish this goal safely.
Despite these setbacks, Wachter concludes that most changes have constituted real progress. "(E)ven our missteps ... have yielded valuable lessons," he said.
Moreover, given the complexity of the healthcare system, he writes, "had I been asked in 1999 how much change in patient safety-related areas would be possible within a decade, I would have substantially underestimated our actual accomplishments."
