Are hospitals getting safer?

Ten years ago a report by the Institute of Medicine, a branch of the National Academy of Sciences, more or less launched the patient safety movement with its estimate that medical error was responsible for something like 50-100,000 deaths annually. That’s a chilling statistic. It’s also one that has been disputed as overblown. But overblown or not, since then all hospitals have made intensive efforts to make them safer places for patients, using things like checklists, time-outs before procedures, and many other simple but crucial things to make sure we are doing the right thing to the right patient. So how are we doing? Are hospitals any safer than they were a decade ago?

Dr. Bob Wachter, one of the gurus of the patient safety movement, recently assessed where we are. His answer is no worse at least, probably a bit better, but not dramatically better. You can read his very informed opinion about it here, on the Health Care Blog. He thinks that, overall, we’ve turned the corner on patient safety and are at last moving in the right direction.

A lot of this research is with adult patients, not children. My own opinion is that the PICU is, in fact, a safer place than it was a decade ago. We are using checklists for common PICU procedures, such as placement of central venous catheters. We are methodical and stringent about looking for signs of skin sores in bedridden PICU patients. Our physician order entry is now all computerized, and the computer regularly picks up problematic orders, things like potentially unsafe drug interactions duplicate orders.

So I’m with Bob; I think hospitals are safer places than they were 10 years ago. We still have a long way to go. The most important thing the patient safety movement has taught us is to take a systems approach to error prevention. Because, as the Institute of Medicine titled their landmark study: “To err is human.”


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