What did we learn about patient safety in 2010?

St. Louis City Hospital

Popular belief holds that due to a “movement” that was launched about a decade ago, patients in hospitals are safer. Although patients are better off year by year due to incremental improvements in medical knowledge and technology there has been little published evidence up to now regarding any impact of the patient safety movement. I blogged last year, following a negative report by the Consumers Union, that the movement was a failure.

Then last month a study was published in NEJM showing no improvements in patient safety over a several year period during the decade of the movement. Following this disappointing report there has been much speculation as to the reasons for the failure. While some ideas, notably central line and perioperative check lists lived up to their promise, others such as CPOE and medication reconciliation, while elegantly simple in concept, failed because they were full of unintended consequences and inscrutably hard to implement in real practice. Other measures such as hand washing, due to their implementation as performance measures, may have had little more than cosmetic impact as I explained here.

I have also maintained for several years that the Institute of Medicine (IOM) report on patient safety, credited by many with launching the movement, actually harmed the cause. Patient safety experts, citing the need for transparency to facilitate discussion and analysis of adverse patient events, were calling for a culture of reduced blame. The IOM report, with its sensationalistic claim that up to 98,000 patients died in the US every year from medical errors, had the opposite effect.

Because the IOM is a subsidiary of the National Academy of Sciences most observers viewed the report uncritically, assuming that it was a scholarly work, despite heavy criticism in the scientific literature and a repudiation of the claim by the lead author of the Harvard Medical Practices study upon which the IOM conclusion was largely derived. In fact, the IOM report was anything but scholarly. It was a massive publicity stunt. Bob Wachter, one of the report's leading enthusiasts, even characterized it as a piece of masterful spin. Its claim of 98,000 deaths by medical error was no more scholarly or fact-based than Sarah Palin's claim about death panels. Despite its flawed nature the popular press gave it a life of its own. Far reaching effects on public perceptions and policy soon followed. I recently examined the public policy consequences of the report and the manner in which it helped produce a culture of provider blame which undermined the cause of patient safety in a guest post at Kevin MD.