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Preventing Fatal Medical Errors: It's Going to Be a Long, Hard Slog

Hospitals are dangerous places for patients, thanks to the generally underappreciated risks of infection and medical errors, which may claim almost 100,000 lives a year in the U.S. That's true even though the Institute of Medicine sounded the alarm more than a decade ago.

The latest evidence: A new report from the National Patient Safety Foundation, which places the blame squarely on deficiencies in the way doctors are educated and a medical establishment that resists change:

Medical schools and teaching hospitals have not trained physicians to follow safe practices, analyze bad outcomes, and work collaboratively in teams to redesign care processes to make them safer.
"Health care remains fundamentally unsafe," says Lucian Leape, a Harvard professor who spearheaded the the NPSF research.

Hospitals, however, remain reluctant to enforce safety edicts against the physicians who provide their bread and butter. Although some have made strides in areas like hand washing and reducing ICU infections, very few are willing to suspend or terminate physicians who violate safety rules. "Meatpacking plants have more accountability than hospitals do," says Peter Pronovost, a Johns Hopkins safety expert and professor of anesthesiology.

The Association of American Medical Colleges (AAMC) notes that its members are trying to improve safety training. But there's lots more to do. To prevent medical students from being intimidated by their superiors, the report says, institutions must guard against abuses of authority. They should also teach patient safety not only to doctors, but also to nurses, pharmacists, and other clinicians. And they should launch "intensive faculty development programs" to educate professors about safety.

This problem is not only economic but also cultural. Just as medical students are afraid to talk back to their professors or raise safety issues, nurses are afraid to stand up to surgeons who won't take a mandatory "time out" to do safety checks before they commence an operation. And in some hospitals, licensed practical nurses who have been assigned to monitor hand washing are afraid to mention violations to regular nurses.

As long as that fear of authority remains and as long as safety is not regarded as paramount, 2 million patients a year will continue to contract infections in hospitals, and 90,000 to 100,000 of them will die as a result.

Image supplied courtesy of Flickr user Jeff Kubina, CC 2.0 Related:

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