Four new medical studies have reported increased patient safety due to reduced medical errors. The studies – in fields from labor and delivery to psychiatry – show that doctors and hospitals can improve patient safety with proper training, staffing, and equipment.
Delivering Babies – It’s safer in New York City
From 2002 through 2009, New York’s Presbyterian Hospital -Weill Cornell Medical Center implemented a comprehensive safety program for its labor and delivery units. The program included independent expert assessment, better communication among labor and delivery medical staff, electronic medical records, and clear policies to quickly handle unresolved issues between medical staff. The Medical Center also increased medical staffing, hired a full time labor and delivery safety nurse, and standardized drugs and their vials. These initiatives, and others, dramatically reduced the Medical Center’s error rate.It also reduced the medical error responsibility of the Hospital to injured babies from 27.5 million to 2.5 million dollars by 2009.
Empowering Nurses to keep patients safe from medical errors
A March, 2011 nursing surveyfound that poor communication between medical staff was deadly to patients in critical care and other acute care settings. Yet over half of the nurses responding to the survey had been in patient care conditions where they felt it unsafe to speak up to correct a medical error. This was true even though a hospital warning system had alerted them to it.
The Study recommended changing hospital cultures so that nurses could speak up about medical errors without fear. It also explained how some nurses used tact, courage, humor, and political skills to help correct medical errors of physicians or co-workers. Finally, the Study recommended that hospitals reward nurses that speak out about medical errors to protect patients, while encouraging medical staff to discuss such issues in a non defensive environment.
Top Performing hospitals finishing strong – the post discharge follow-up
Some hospitals have also gained on patient safety. An April, 2011 reporttracked four top performing hospitals in the Western United States. All had significantly reduced post discharge readmission rates for patients – a significant indicator of good patient outcome. Among the findings: a focus on clinical excellence and quality improvement strategies marked all four hospitals. Their electronic medical records, and software identifying high risk patients, also helped produce the favorably low rate of hospital readmissions.
The report also confirmed the key role of patient education in good patient outcomes. Hospital staff taught patients to recognize warning signs of complications or a worsening condition, and the importance of post discharge medical care to the patient’s recovery. Patients had to “teach back” these lessons to hospital staff before discharge to confirm that the patient understood the teaching.
Once a patient left the hospital, medical staff extended a high level of post discharge care, particularly to high risk patients. These patients were elderly, poor, or
suffered from heart failure or complex medical needs. Hospital staffs monitored vital signs through telemetry, and telephoned high risk patients to confirm their condition.
Finally, the Hospitals ensured continued care after discharge by placing patients into integrated medical care networks in the community. Patients therefore were less likely to end care when they left the hospital, and more likely to have post discharge conditions diagnosed before those conditions became critical.
The Devil in the Details — Reducing Medication Errors at a Psychiatric Hospital
In 2003, the John Hopkins Hospital psychiatric unit in Baltimore, Maryland chose to address its medication error rate of 27 for every 1000 patient hours. A medication error means that a patient has been given the wrong drug, or the wrong amount of the right drug. Either error can kill or disable a patient.
Over the next four years, the Hospital installed an electronic medication order entry system linked to prescription and patient information. This system blocked wrong medications or doses from reaching the patient. By 2007, this, along with staff training, had reduced the medication error rate to 3.43 with no deaths or adverse events. This significantly improved patient safety on the psychiatric unit.
