University of Missouri - Columbia.
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Posted 12.14.05

MU Survey in JAMA Finds Less than Half of U.S. Hospitals Budget for Patient Safety

Study Indicates Safety Systems Should be Reviewed, MU Researcher Says

COLUMBIA, Mo. Five years ago, the Institute of Medicine (IOM), a component of the National Academies of Science, reported on medical errors and quality saying serious and widespread problems occurred in all areas of the country. The IOM advocated improving patient safety through systematic changes. In a new study in the December edition of the Journal of the American Medical Association, University of Missouri-Columbia researcher Daniel Longo found that hospital patient safety systems still do not meet the IOM recommendations and efforts for improvement need to be enhanced.

"There has been progress in patient safety systems, but it has been modest at best," Longo said. "While there have been some improvements in the past five years, policy makers need to look at these results and examine incentives to encourage hospitals and healthcare providers to improve their patient safety systems. This is not about what is wrong; it is about encouraging the healthcare industry to improve the entire system."

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In the study, Longo and his research team surveyed more than 125 hospitals in the Midwest and West. The survey included 91 questions about patient safety systems and was distributed at two different times over an 18-month period. Patient safety systems were defined as the various policies, procedures, technologies, services and numerous interactions necessary for the proper functioning of hospital care.

Statistical analysis of hospital administrators' responses to the survey included grouping the safety system components into seven categories. These categories were: existence of a computerized physician order entry system, computerized test results and assessments of adverse events; specific patient safety policies; use of data in patient safety programs; drug storage, administration and safety procedures; manner of handling adverse event or error reporting; prevention policies; and root cause analysis procedures.

In his study, Longo found that 74 percent of hospitals reported full implementation of a safety plan, while 9 percent reported that they had no written plan. In addition, only 34 percent of hospitals reported full implementation of a computerized physician order entry system for medications. Such systems are important because they help prevent human errors, including interpretation of prescriptions, and mathematical errors.

"Given the growth of computer technology in general and in hospital billing systems, it is disappointing to find such high percentages of hospitals that report no attempt to implement computerized physician order entry systems," Longo said. "If implemented, these systems influence hospital environment, reduce the probability of error, and improve the probability of safety."

More than half of all the hospitals surveyed reported a lack of budget or funds to implement a patient safety program. According to the results, less than 40 percent of hospitals reported having a budget for patient safety programs.

Longo said that implications of the study vary. Doctors and medical boards of directors should be asking if patient safety systems are in place at their hospitals. Policy makers and legislative leaders should create incentives to encourage these types of systems throughout the country.

Individual patients should speak candidly with their doctor before being admitted to a hospital. Longo said that while there may be no choice in emergencies, patients might be able to influence a hospital decision for an upcoming scheduled surgery.

"Response from within the health care system clearly has been slow. Hospitals may be safer today than when the IOM report was issued, but the work must be accelerated," Longo said. "We have learned that the complex problems of hospital safety cannot be solved by placing blame on a single individual when an error occurs. We need to work to identify how the entire system operates and see if there is some way to fix the problem from a system point-of-view."



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