Patient safety in community-based teaching hospitals

Abstract

It has been over 10 years since the Institute of Medicine (IOM) re-ignited the patient safety movement in the United States with their publication ‘To Err is Human’. Five years after that publication there were modest improvements in certain indicators like death in low mortality Diagnosis Related Groups (DRGs), iatrogenic pneumothorax, and certain postoperative complications. At that time there was actually worsening in the rates of hospital acquired decubitus ulcers and postoperative deep vein thromboses and pulmonary emboli (1). Five years after the IOM report, leaders in patient safety such as Lucien Leape, Donald Berwick (2), and Robert Wachter (3) described safety systems that were then in their infancy (or at best early adolescence). These included specific tools like electronic health records and computerized physician order entry systems, as well as safe practices like improved team training, sharing of best practices, and full disclosure to patients following injuries. Strategies to encourage the development of these systems included ‘pay for performance’ schemes, non-payment for ‘never events’, regulation and accreditation, better reporting systems, funding for health information technology, malpractice reform, and workforce and training systems were identified. In January 2010, Robert Wachter added to this list of safety reform systems additional elements (4). Some of which were identified in the IOM report. These were policies to promote safety research, better ways to engage patients and their families in the avoidance of errors, internal leadership, and the creation of business models that encouraged safety and national and organizational support (5). (Published: 18 July 2011) Citation: Journal of Community Hospital Internal Medicine Perspectives 2011, 1 : 6433 - DOI: 10.3402/jchimp.v1i2.6433