Significant improvements have been made in hospitals to ensure patient safety since the Institute of Medicine released a landmark report in 2000 that revealed many thousands of Americans die each year because of medical mistakes.
But nationwide, the pace of change is painstakingly slow, and the death rate has not changed much, according to the study in today's Journal of the American Medical Association. The researchers blame the complexity of health-care systems, a lack of leadership and the reluctance of malpractice-shy doctors to admit errors.
"The medical community now knows what it needs to do to deal with the problem. It just has to overcome the barriers," says study co-author Lucian Leape of Harvard's School of Public Health.
The institute, a nonprofit public policy organization, pushed key health-care organizations to turn their attention to patient safety, the new report says. As a result, reductions as high as 93 percent have been made in certain kinds of error-related illnesses and deaths.
Computerized prescribing, adding a pharmacist to medical teams and team training in the delivery of babies are among the improvements medical centers are making, the study finds.
But "we have to turn the heat up on the hospitals," Leape says.
For example, 5 percent to 8 percent of intensive-care patients on ventilators develop pneumonia, the study says. But by following a simple protocol of bed elevation, drugs and periodic breathing breaks, those outbreaks can be reduced to almost zero. "A little hospital in DeSoto, Miss., called Baptist Memorial did it, so it doesn't take a big academic medical center," Leape says.
There's no economic incentive for hospitals to reduce errors because they make more money by treating the resulting problems, researchers say.
Instead, hospitals that eliminate infections should receive bonuses, Leape says. "If insurance companies paid 20 percent more for patients in (intensive-care units) where there were no infections, they'd cut costs substantially.
"We've learned how to redesign our systems, and we've shown it can have a big impact. We've now got dozens of demonstration projects. Now the challenge is rolling those changes out to 5000 very different hospitals."
By Elizabeth Weise / USA TODAY