Evidence-based safety practices touted by government

Patient safety data will be widely shared with those responsible for safety initiatives at U.S. health care institutions.

By Damon Adams, amednews staff. Aug. 6, 2001.

A new federal report on patient safety practices identifies 11 practices that are proven to work but are not used routinely in hospitals across the country.

The report by the Agency for Healthcare Research and Quality said such proven practices include giving patients antibiotics just before surgery to prevent infections, having surgery patients take beta blockers to prevent heart attacks during or after operations and using ultrasound to help guide insertion of central intravenous lines and prevent punctured arteries and other complications.

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The research is intended to help the health care community make decisions on improving patient safety.

"We are sharing these findings with health care administrators, medical directors, health professionals, and others who are responsible for patient safety programs," said Health and Human Services Secretary Tommy Thompson. "The nation's health care leaders need to know what the science says about where the opportunities exist to make patient care safer right now."

The study, "Making Health Care Safer: A Critical Analysis of Patient Safety Practices," is part of the federal government's response to a 1999 Institute of Medicine report that found that up to 98,000 people die yearly because of medical errors at hospitals. The agency, which reports to HHS, is the federal agency leading efforts to research and promote patient safety.

"This is a chance for us to try to help the nation improve in the areas where we said we needed improvement," said agency director John Eisenberg, MD.

AHRQ's Evidence-based Practice Center at the University of California at San Francisco/Stanford University reviewed research on 79 patient safety practices. Researchers focused on care delivered at hospitals and found 73 practices that are likely to improve patient safety, including the 11 viewed as highly proven to work.

The Chicago-based American Hospital Assn. expects hospitals to review the data.

"They will be looking to evaluate their practices against what's recommended by the AHRQ report," said Don Nielsen, MD, senior vice president for quality leadership for the AHA. "A lot of these practices are already in place."

Researchers found that more than a dozen practices considered important by patient safety experts had not been studied enough and were not placed among the top 11 practices. The insufficiently studied practices included use of computerized physician order entry and changes in nurse staffing ratios.

More research is needed in these and other areas, agency officials said.

Carolyn Clancy, MD, director of the AHRQ's Center for Outcomes and Effectiveness Research, said practitioners want to do the right thing for patients but don't always know what that is.

"Today, we give them that evidence," Dr. Clancy said during the report's release July 17.

The 643-page study has been sent to the National Quality Forum, a nonprofit organization charged with developing a national strategy for health care quality measurement and reporting. The forum will expand on the report and develop a guidebook for hospitals, practitioners, consumers and purchasers that lays out which practices should be used by hospitals.

A draft may be available by year's end, with a completed guidebook to be released in April 2002.

"We have a lot of work to do, and the report helps get us on the way," said Kenneth W. Kizer, MD, MPH, president and CEO of the Washington, D.C.-based forum.

In the next few months, the AHRQ will award about $50 million to support additional research. In the meantime, agency leaders said the new report gives health care professionals the evidence they need to begin creating safer environments.

"There is a will in American health care to do better," said agency director Dr. Eisenberg, "and now we are providing them with a way."