Following certain strategies could save the lives of the many patients who die in US hospitals because of unsafe practices by health care workers, a team of investigators report today in a supplement of the Annals of Internal Medicine.
Each year, diagnostic errors result in the deaths of an estimated 44 000 to 80 000 patients, and many thousands die because of teamwork and communication errors affecting their care or because they do not receive necessary evidence-based interventions. Nearly 68 000 patients die from complications associated with bed sores, a largely preventable occurrence.
To address such problems, a team of investigators from RAND Health; Stanford University; the University of California, San Francisco; and Johns Hopkins University, commissioned by the federal Agency for Healthcare Research and Quality, examined evidence supporting useful measures and issued their “top 10” list of evidence-based strategies to improve patient safety. These include
• Following preoperative checklists and anesthesia checklists to prevent operative and postoperative events
• Using checklists of steps to take to prevent central line–associated bloodstream infections
• Using interventions to reduce urinary catheter use
• Preventing ventilator-associated pneumonia through measures such as elevating the head of the patient’s bed, temporarily discontinuing use of sedatives, addressing oral care with chlorhexidine, and suctioning endotracheal tubes
• Giving appropriate attention to hand hygiene
• Following a “do-not-use list” for abbreviations that could be misunderstood, leading to medical errors
• Using a group of interventions to reduce bed sores, such as repositioning and monitoring the patient’s skin
• Using barrier precautions (such as face masks and gowns) to prevent health care–associated infections
• Guiding placement of a central line with ultrasonography
• Using interventions to improve prevention of venous thromboembolism
In an accompanying editorial, several of the investigators noted that further research is needed on a variety of issues, such as developing better measures of harm and context, organizing a safety program, and integrating systems engineering approaches into clinical environments. “A decade ago, our early enthusiasm for patient safety was accompanied by a hope, and some magical thinking, that finding solutions to medical errors would be relatively straightforward,” they wrote. Acknowledging the naivete of that point of view, they went on to say, “Making patients safe requires ongoing efforts to improve practices, training, information technology, and culture.”