In the book “Checklist,” Harvard Medical School professor and surgeon Atul Gawande writes about the power of a simple list in healthcare. Consistently using a checklist in operating and emergency rooms can prevent major errors and save lives.
Medical errors — even glaring ones, such as operating on the wrong limb or leaving a surgical instrument inside the body — occur surprisingly often. In 2013, a careful study made waves when it estimated that more than 400,000 people die every year in the United States from preventable harm suffered in hospitals. Up to a third of hospital patients suffer an adverse event during their hospitalization, and 7 percent die, according to a 2011 estimate. The study did not evaluate whether the harm was due to a preventable error, but that’s a significant number, considering that we go to the hospital to get better, not worse.
The government is getting tougher on preventable errors. In December 2014, the Medicare system penalized more than 700 hospitals for having high-rates of avoidable errors such as infections. (See the full list here.) In fact, a 2015 review of 80 studies about hospital cleanliness, critical for reducing hospital-acquired infections, found there isn't much evidence-based research into hospital cleaning practices and their effectiveness.
Doctors have long been immune from criticism, Harvard’s Gawande writes. Yet, he says, simple changes like empowering nurses to enforce the steps on a checklist with doctors have resulted in dramatic reductions in error, infection, and complication rates at hospitals around the country.
Some doctors and hospitals may still be resistant to easy fixes like a checklist. But that’s counterproductive, says Erica Mobley, director of communications at the Leapfrog Group, an independent nonprofit that rates hospitals for safety. Hospitals should embrace the growing focus on patient safety, she says, because it will ultimately save lives — which is what hospitals want.
Many hospitals are getting smarter about safety, Mobley notes. An electronic patient-tracking system can issue an alert when prescribing an adult dose of a medication for a child, for example. Some hospitals use wrist bands with bar codes that must be scanned when a patient is given a dose of medication. The device matches the prescription to the patient and tracks each time a pill is taken.
These efforts are having an effect: between 2010 and 2013, adverse events dropped 17 percent nationwide, according to a government report that reviewed tens of thousands of medical records. That reduction translates to saving an estimated 50,000 lives. Another report from the Centers for Disease Control and Prevention found an across-the-board decrease in all forms of hospital-acquired infections in 2013.
Yet experts widely agree much more should be done. In the meantime, to protect yourself in the hospital, Mobley suggests:
August 14, 2015
Christopher Nystuen, MD, MBA