Safe, High Quality Care Around the Clock: What will it Take to Get us There?

Abstract

In Crossing the Quality Chasm1 the Institute of Medicine called for improvements in six dimensions of health care quality: safety, effectiveness, patient-centeredness, timeliness, efficiency and equity. The report suggests that these improvements cannot be achieved within the constraints of the existing system of care. In this issue of the Journal, Wong et al., make a similar argument, proposing that our current “office hours” system of hospital care is incapable of providing high quality health care on nights and weekends.2 The authors concerns over temporal care disparities are warranted. The evidence provided for mortality differences in weekend admission for acute myocardial infarction(AMI), upper gastrointestinal bleed(UGIB), acute pulmonary embolus(PE) and pneumonia make a compelling case for reforming the way care is provided.3–6 Reports of less aggressive care during off hours, higher rates of surgical complications and medical errors as well as higher mortality from cardiac arrest only serve to strengthen their assertion.7,8 It is unacceptable for a patient’s experience or outcome to differ by time of day or day of week. The challenge lies in identifying the most effective and efficient means to eliminate these disparities.