Temporal Trends in Rates of Patient Harm Resulting from Medical Care”, New England Journal of Medicine, 11/25/2010. Read at http://tinyurl.com/297884t

This new study reviewed 2,341 patients’ records from stays at 10 North Carolina hospitals from 2002 to 2007. The reviewers found that 25 harms per 100 admissions had occurred, and that 63% of these harms were preventable. Harms that were detected were a consequence of procedures (186), medications (162), nosocomial infections (87), other therapies (59), diagnostic evaluations (7), and falls (5), among other causes. The large majority of identified harms were classified as category E or temporary harm (144) or category F or an initial or prolonged hospitalization (163) harms. Of the identified preventable harms, 13 caused permanent harm (category G), 35 were life-threatening (category H), and 9 caused or contributed to a patient’s death (category I).

The authors concluded harm to patients resulting from medical care was common in North Carolina, and the rate of harm did not appear to decrease significantly during a 6-year period ending in December 2007, despite substantial national attention and allocation of resources to improve the safety of care. Since North Carolina has been a leader in efforts to improve safety, a lack of improvement in this state suggests that further improvement is also needed at the national level.

What is holding us back from making patient care safer? The authors pinpoint these factors:
Despite substantial resource allocation and efforts to draw attention to the patient-safety epidemic on the part of government agencies, health care regulators, and private organizations, the penetration of evidence-based safety practices has been quite modest. For example, only 1.5% of hospitals in the United States have implemented a comprehensive system of electronic medical records, and only 9.1% have even basic electronic record keeping in place; only 17% have computerized provider order entry. Physicians-in-training and nurses alike routinely work hours in excess of those proven to be safe. Compliance with even simple interventions such as hand washing is poor in many centers.

If North Carolina, which has aggressively pushed patient safety, has not improved in 6 years, what is going on in the rest of the country?

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