Editor's Comment on Patient Safety Issue 3.2013

All aspects of healthcare are changing. Patient safety is a global priority and when we hear that the mortality rate due to error equates to five jumbo jets crashing once a week there is no hue and cry from the public or the government as there would be if it were airliner crashes. World train crashes warrant more coverage!

Why is this the case? No healthcare professional goes into medicine to kill patients! They enter the profession to give care and save lives. Given how complicated our bodies and brains are, it is not surprising medical science does not understand all of the intricate workings of either.

Forty years of research has been done to cure cancer but the reduction in cancer rates occurred more from smoking cessation than all research.

The healthcare profession is well aware of the problems and have for the last 20 years made changes in education, training and embraced technology to rectify the problem. However, with all the changes in the educational system and in the reduction of work hours and new technologies the problem still exists.

In the US in the early 2000s the ACGME limited working hours for resident staff from 100 hours to 80 hours per week (still the highest in the world with Sweden the lowest at 35) citing patient safety and resident burnout as the reason. In reality, pressure from organizations and politicians because of media coverage of error and mistakes influenced the decision. Advocates for the change felt care of patients and learning would both improve.

Ironically in a recent study in Journal of General Internal Medicine that looked at the difference in mortality rates pre and post reduced work hours there was no significant change in mortality. However, there was a perception that hand-off of patients post reduced work hours was not as efficient.

There have been tremendous technological advances that help doctors diagnose (ultra sound, advanced MRI) and treat disease and enhanced surgical procedures (minimally invasive surgery and now robotic surgery) that are less invasive for the patient. However, the problem still exists.

Great strides have been made in team training and inter-professional training from the medical school, nursing school level to hospital teams working as units and in robotic surgery where every team member has a role to play and must communicate efficiently and effectively with all team members. Communication among and between healthcare teams, doctors, nurses, pharmacist, anesthesiologist is a top priority in current training and the problem still exist.

It has been estimated that 80% of avoidable errors in healthcare are due to failures of communication within and across the teams of people charged with the care of patients. The cost in lives and money of these errors is, by any calculation, unacceptable.

Reports also highlight the fact that Healthcare is now the most dangerous occupation for its workforce with over 650,000 workplace injuries a year (2010 figures). "We remain concerned that more workers are injured in the health care and social assistance industry sector than in any other, including construction and manufacturing, and this group of workers had one of the highest rates of injuries and illness at 5.2 cases for every 100 workers," Labor Secretary Hilda L. Solis said in October, 2011. And this is down from each of the prior year reports.

If we are to improve ‘patient safety,’ the watchword of our sector, as well as ‘workplace safety’ then we must improve the education and training of people working in healthcare.

Other high risk industries such as Nuclear Power and Airlines, whose existence depends on an exemplary safety record and which are held up to public scrutiny at a level not (yet) seen in Healthcare, have developed safety management systems and tools including robust training methods to equip their personnel to succeed.

They did so via a rigorous study of their processes and practices leading to a raft of standard operating procedures then standardized training and assessment of their personnel to ensure the successful implementation of those new, safe, work practices.

The demand from patient groups, government, learned bodies and the professions themselves is for Healthcare to now do the same. As in the industries mentioned above, this fundamental change to our sector must be initiated by those who work within it; the broader Healthcare community.