Clear message on patient safety

As the patient safety movement gathers momentum, the overriding goal must be to improve the care of patients and to reduce medical injury to the lowest possible level.

Editorial. Jan. 17, 2000.

A recent series of events has placed in sharp focus a growing concern for patient safety issues.

Late November's headline-grabbing Institute of Medicine report on medical mistakes -- and the estimated 44,000 to 98,000 hospital deaths each year they cause -- included a wide-ranging group of recommendations, such as a call for the establishment of a federal Center for Patient Safety. On release of the IOM report, President Clinton ordered government agencies to determine what recommendations they could implement. The report also prompted immediate talk of federally legislated adoption of the recommendations.

Momentum for a health-industrywide attack also has been building for some time. As reported in the Nov. 22/29, 1999, edition of American Medical News, the Medical Group Management Assn. has announced an initiative to develop ways to reduce the incidence of medical injury to patients in ambulatory care settings. The move by the MGMA, an association of more than 8,000 group practices, will target a problem that has received relatively little attention in previous initiatives, which have focused primarily on care in hospitals and other institutional settings.

By coincidence, that same issue carried the chilling story that a Texas jury had concluded that an illegible prescription written by a physician had caused the death of a 42-year-old patient. The jury entered a $225,000 judgment against the physician and an equal judgment against the pharmacy that had dispensed Plendil instead of Isordil to a patient who subsequently died of a heart attack. The verdict was believed to be the first in which a physician's handwriting had been directly blamed, and appears to be a clear illustration of the growing level of mistrust of the medical profession by members of the public.

The actions of the MGMA and the Institute of Medicine are logical extensions of work begun in 1997 by the National Patient Safety Foundation. The NPSF was founded in large part through the efforts of the AMA and was the first national-level organization to focus on patient safety.

The evolving roles of the NPSF, the Institute of Medicine, the MGMA, and other entities active in this arena will bear close scrutiny. Clearly, there is a potential for conflict, turf battles and bureaucratization, but joint action in addressing patient safety issues has the potential tor achieve more beneficial results for patients.

The past chair of the NPSF, Nancy W. Dickey, MD, has emphasized that "collaboration, not competition," will lead to success in the future. She, too, called for a new and close examination of the care being delivered in ambulatory settings, which increasingly are taking on a greater load of patient care. The Institute of Medicine will focus first on hospitals, where rapid advances in technology are a major factor in accidents.

Some thorny issues must be resolved in the coming months, including what form reporting procedures will take and how much information will be made public. But as the patient safety movement gathers momentum, the overriding goal must be to improve the care of patients and to reduce medical injury to the lowest possible level. Some problems may best be solved by collaborative efforts by many organizations. Others may be specialty-specific and better addressed by a specialty organization. As the catalyst in formation of the NPSF, the AMA has made a major contribution to the effort.

In the final analysis, however, patient safety is everybody's business, and there are ample opportunities for the entire health care industry to work toward this goal.