In a commentary in the Journal of the American Medical Association, patient safety expert Peter Pronovost, MD, PhD, a professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine, writes that the health care industry doesn’t yet have measurable, achievable, and routine ways to prevent patient harm. In many cases, he adds, there are too many barriers in the way to attain them.
Pronovost argues that one of the most important first steps is to eliminate the arrogance of physicians who are over confident about the quality of care they provide and who believe things will go right and aren’t prepared when they don’t, and hospital officials who fail to aggressively address problems like hospital-acquired infections.
Despite ongoing efforts to improve patient safety, there is limited evidence of improved patient outcomes, he says. The same scientific rigor applied to other areas of medicine needs to be applied to the study of patient safety. He acknowledges, however, that the science of patient safety is immature and underfunded.
Pronovost points to the success of a simple checklist he introduced into hospital ICUs at Johns Hopkins and then the entire state of Michigan that showed the number of central line-associated bloodstream infections—which are common and costly and kill 31,000 patients a year in the United States—could be reduced to nearly zero. Once thought of as an inevitable risk associated with a hospital stay, Pronovost’s work has shown they can be largely avoided.
The checklists alone, however, did not lead to the dramatic improvements in patient safety in these ICUs, he writes. Equally important was changing the prevailing medical culture of each institution. In the new culture, nurses are allowed—even encouraged—to question doctors who may have skipped a step or otherwise violated safety protocols. Feedback is given constantly on infection rates so everyone knows the extend of the problem.
In the commentary, Pronovost also points out that many hospitals won’t report their infection rates publicly. Without knowing how big the problem is, he argues, how can it suitably be addressed.
The work to reduce these bloodstream infections is spreading to other states and there is a federal mandate to reduce them by 75% over three years—the “first quantifiable patient safety goal in the United States,” he writes. Still, in some states fewer than 20% of hospitals have volunteered to participate.
“Some hospitals have reduced infections, most have not,” Pronovost says. “Some hospitals claim they use the checklist, despite having high or unknown infection rates. Some hospitals are content to meet the national average, despite evidence that these rates may be reduced by half. Some hospital administrators say their patients are too sick; these infections are inevitable. Yet, intensive care units in several large academic hospitals have nearly eliminated CLASBIs, or central-line associated bloodstream infections. Some hospitals blame competing priorities for their inattention to these infections. If these lethal, expensive, measurable, and largely preventable infections are not a priority, what is?”
Pronovost maintains that holding hospital leaders accountable for infection rates, getting financial incentives from insurers for reducing infections, and, when needed, imposing regulatory sanctions, can remedy the problem.