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Thursday, March 8, 2012

Blah blah patient safety blah blah

This is Patient Safety Awareness Week, an annual observance of the National Patient Safety Foundation. Every year my CEO raises the same objection: if we are all about patient safety, why do we need an annual observance?  If I were a patient, he says, I would hope that every week is "PSAW."

Good point.  The problem with a concept like "patient safety," however, is that with repetition the term can become leeched of all meaning.  It drives me nuts to hear someone being interviewed about this and offer that the point of patient safety is "to keep patients safe."  Bland platitudes are not what we need.

Not when the mandates of the 1999 Institute of Medicine report are largely unmet.  Not when checking into a hospital is roughly comparable to bungee jumping for "safety."  And certainly not when it is still all too common for healthcare professionals to inflict avoidable harm on patients.  When we talk about "adverse outcomes" in this context we need to be crystal clear - we are talking about something that we did to the patient, or failed to do correctly, that left them temporarily injured, permanently disabled or dead.  Something that was not the result of their underlying illness, but of our "care."

It is fair to say that we have made inroads.  The rate of some avoidable hospital infections has plummeted.  Physicians have begun embracing standardized order sets that help them not to forget things that ought to be part of the patient's treatment plan.  (This was no easy feat:  it took years for us to get over the loss of status.  If we're perfect, after all, why should we use such a crutch?  It's as insulting as asking the flying Wallendas to start using a net!)  We even use checklists in the operating room, just like cockpit crews.

Well, not exactly.  Unlike cockpit protocols, which have resulted in huge strides in aviation safety,  OR standardization has yet to bear the same fruit.   As a matter of fact, according to statistics maintained by the Joint Commission, the number of (reported) wrong-patient, wrong-procedure or wrong-side operations has only increased since such protocols were implemented.  It's not clear why.  The most cynical have suggested, however, that while surgeons may be adversely affected by operative accidents, there's nothing like being at the pointy end of a 100 meter projectile to focus one's attention on safety.

Personally, I don't buy this.  The fact is that Medicine is a very messy affair, and its practitioners are accustomed to this disorder.   Which means that it will take time and the work of provocateurs to keep us on the path to dramatic improvement and away from comfortable and familiar cliches like "patient safety."

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