December
14, 2005 I JOURNAL OF THE AMERICAN MEDICAL
ASSOCIATION
The Long Road to Patient
Safety
A Status Report on Patient Safety Systems
Daniel R. Longo, OblSB, ScD;
John E. Hewett, PhD; Bin Ge, MD, MA; Shari Schubert,
BA
JAMA. 2005;294:2858-2865.
Context Since the Institute
of Medicine (IOM) reports on medical errors and quality,
national attention has focused on improving patient
safety through changes in "systems" of care.
These reports resulted in a new paradigm that, rather
than centering on individual errors, focuses on the
"systems" necessary to facilitate and enhance
quality and protect patients.
Objectives To assess
the status of hospital patient safety systems since
the release of the IOM reports and to identify changes
over time in 2 states that collaborated on a patient
safety project funded by the Agency for Healthcare Research
and Quality.
Design, Setting, and Participants
Survey of all acute care hospitals in Missouri
and Utah at 2 points in time, in
2002 and 2004, using a 91-item comprehensive questionnaire
(n = 126 for survey 1 and n = 128 for survey 2). To
assess changes over time, we also studied the cohort
of 107 hospitals that responded to both surveys.
Main Outcome Measures Responses
to the 91-question survey as well as changes
in responses to the survey questions over an 18-month
period. Seven latent variables were constructed to represent
the most important patient safety constructs studied:
computerized physician order entry systems, computerized
test results, and assessments
of adverse events; specific patient safety policies;
use of data in patient safety programs; drug storage,
administration, and safety procedures; manner of handling
adverse event/error reporting; prevention policies;
and root cause analysis.
For each hospital, the 7 latent variables were summed
to give an overall measure of the patient safety status
of
the hospital.
Results Development and
implementation of patient safety systems is at best
modest. Self-reported regression in patient safety systems
was also found. While 74% of hospitals reported full
implementation of a written patient safety plan, nearly
9% reported no plan. The area of surgery appears to
have the greatest level of patient safety systems. Other
areas, such as medications, with a long history of efforts
in patient safety and error prevention, showed improvements,
but the percentage of hospitals with various safety
systems was already high at baseline for many systems.
Some findings are surprising, given the overall trends;
for example, while a substantial percentage of hospitals
have medication safety systems, only 3% reported full
implementation at survey 2 of computerized physician
order entry systems for medications, despite the growth
of computer technology in general and in hospital billing
systems in particular.
Conclusions The current
status of hospital patient safety systems is not close
to meeting IOM recommendations. Data are consistent
with recent reports that patient safety system progress
is slow and is a cause for great concern. Efforts for
improvement must be accelerated.
Author Affiliations:
Department of Family and Community Medicine (Dr Longo
and Ms Schubert) and Biostatistics Group (Drs Hewett
and Ge), School of Medicine, University of Missouri–Columbia. |