NYT Reports On Patient Safety Progress

A Better Way to Keep Patients Safe
By PAULINE W. CHEN, M.D.


Not long ago, a few colleagues and I were discussing the challenges of improving health care quality and patient safety. We debated the merits of clinical benchmarks that payers and regulatory groups now require, crude proxies of quality care like giving antibiotics at certain times, ordering specific tests at set intervals or permitting our results to be reported publicly.
One colleague, a devoted and highly respected clinician in his department, admitted that he found this growing list of directives from others exasperating. “I’m all for taking great care of patients,” he said, the muscles along his jaw tightening. “But how can some insurance bureaucrat or policy wonk who’s not in the clinical trenches know more about taking good care of real patients than someone like me?”

Since 1999, when a national panel of experts released landmark report on the high number of medical errors, insurers, policy makers and regulatory groups have been piling onto the quality-improvement wagon with ever increasing gusto. As a result of their enthusiastic efforts, hospital accreditation procedures and standards have become more rigorous, physician duty hours have been trimmed, hand-sanitizing gel dispensers in hospitals have multiplied and physician reimbursement has been linked increasingly with quality goals and less with the number of CT scans ordered.

But few of these quality enthusiasts are actually caring for patients. And when a study in The New England Journal of Medicine last fall reported that despite all the efforts and new financial incentives, there was no significant decrease in patient injuries, these same enthusiasts were quick to point to the inertia and intractable attitudes of the medical “culture.” They noted that less than 2 percent of hospitals had installed comprehensive electronic medical records systems, doctors and nurses were routinely working in excess of limits on duty hours and few were paying attention to even simple hand-washing recommendations. It would take nothing short of an all-out legislative, financial and regulatory assault to change the system, many of them concluded.

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