April 2000 • Volume 6 • Number 4
Repercussions of IOM study could make care safer
BY JANE STOEVER
Fallout from an Institute of Medicine report could make health care less hazardous to everyone's health.
In November, the IOM issued To Err Is Human: Building a Safer Health System, the first of five IOM studies on health care. Preventable errors in U.S. hospitals kill from 44,000 to 98,000 patients a year, said the IOM. It called for the errors to be cut by 50 percent within five years.
Policy-makers sat up and took notice. Congressional panels studied the report, and President Bill Clinton proposed $20 million for a patient safety center.
Safer primary care
Ambulatory settings as well as hospitals are fair game for safety enhancements, says IOM member Joseph Scherger, M.D., M.P.H., who helped write the report. Scherger, a former AAFP director, is associate dean of the University of California medical school in Irvine.The report, which deals mostly with hospital care, recommends information systems to override the possibility of human errors. "When we check in our luggage at the airport, it's not human beings who write down the flight number. It's done electronically," says Scherger. "We also need safe prescribing systems, to make sure patients get the right medicines, the right dosages."
Scherger targets procedures and the injection of powerful medications as danger zones.
"Very often, ambulatory settings are ill prepared to deal with emergencies, such as someone having a strong allergic reaction or decreased breathing," he says. "In my experience in many family practice offices, usually no one has turned on the oxygen tank in a long time to see whether it works. We aren't ready to respond quickly."
Eighteen states already require confidential reports on serious errors. The IOM would expand that to all states.
When a jet crashes, the airline must report the accident, investigators search for the cause, and inspectors check out similar planes to prevent more tragedies. "What happens when a bad thing happens in a medical environment?" asks Scherger. "Is there an immediate response? Do we share information? Are other health care sites checking to make sure they don't have the same thing happen?
"We're still very much a cottage industry, loosely run, locally controlled. More safety will mean more standards."
AAFP supports spirit of report
On March 16, the AAFP Board of Directors voted to support the spirit of the Institute of Medicine report on medical errors. The Board committed the Academy to studying steps to enhance safety in family physicians' practices.
AHRQ's role
The patient safety center suggested by IOM will be part of the Agency for Healthcare Research and Quality (formerly the Agency for Health Care Policy and Research)."We may find ways to help physicians and their staffs educate patients better and prevent errors," says AHRQ Director John Eisenberg, M.D. "We'll consider things like using computer systems to flag lab results that aren't normal and to alert physicians."
States will collect data on errors in a way that prevents identification of individual doctors and patients. "Health systems will be identified," says Eisenberg, "because we need system solutions."
He adds, "We hope we can help physicians understand where there are opportunities for errors and what they can do to avoid them. We understand resources are limited, staffing is limited. So we need to find efficient ways of identifying errors and then avoiding them."
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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