Saturday, November 27, 2010

Eliminating harm: The science of delivery

What would Deming say about this?

Two studies released back to back this month found a lack of significant change in eliminating harm due to medical error within the samples studied.

A study of 780 Medicare patients discharged from hospitals in October 2008 found that 12 died as a result of hospital care. The HHS report estimated that 15,000 Medicare patients die each month in part because of the hospital care they receive. Temporary harm occurred in another one in seven patients whose care-related problems were detected in time and corrected.

In a second study conducted over a six-year period at 10 randomly selected hospitals in North Carolina using the IHI Global Trigger Tool, internal reviewers identified 588 instances of patient injury among 2,341 admissions, for a rate of 25.1 per 100 admissions. Of the 588 instances of harm identified by internal reviewers, 63.1% were classified as preventable. Injuries involved procedures in 186 cases, medications in 162, nosocomial infections in 87, other therapies in 59, diagnostic evaluations in seven, and falls in five; other causes accounted for the rest. Most of the adverse events were temporary, requiring either intervention or initial or prolonged hospitalization, although 8.5% were life-threatening, 2.9% were permanent, and 2.4% caused or contributed to death. Researchers concluded there were no significant changes in the rate of overall harms identified by internal review, or in the rate of preventable harms, over time.

Medical mistakes are "an enormous public health problem," said Peter Pronovost of Johns Hopkins University, co-author of the book Safe Patients, Smart Hospitals.

Although this may feel discouraging, I believe there is a unique opportunity before us. We are, without question, at a point in history where change is not only possible, it's inevitable. These studies point to the gap in what is known about "how to" deliver evidenced-based health care reliably to the public. "We spend two pennies trying to deliver safe health care for every dollar we spent trying to develop new genes and new drugs," Pronovost told USA Today earlier this month. "We have to invest in the science of health care delivery." I agree that there is more we can do with a systematic approach. We can and should look to other countries who have taken on such efforts on a national scale. I believe we are better positioned than we have ever been to transform the experience of care in our nation. We must let go the old ways of thinking and challenge the self imposed limits we have come to accept and believe about what is possible.
"It is not necessary to change. Survival is not mandatory." -W. Edwards Deming
To my first question, what might Deming say to us? Although we will never know, we needn't look far to find clues to what his position might be.


Here are the studies below:

Landrigan C, et al "Temporal trends in rates of patient harm resulting from medical care" N Engl J Med 2010; 363: 2124-2134.

US Department of Health and Human Services. Office of Inspector General. Adverse events in hospitals: National incidence among medicare beneficiaries.

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