Patient safety: A public health crisis for a nation of patients

The United States is a nation of patients. More than 300 million Americans — 95 percent of us — encounter the nation’s health care system at least once in the space of five years. It’s essential that every health care encounter is safe and free from harm. Sadly, that isn’t the case.

Our daughter, Meredith, died not from the cancer she had been so bravely fighting but from a health care-associated infection that should have been preventable and for which there was no effective antibiotic. Meredith isn’t an exception. The Centers for Disease Control and Prevention estimate that nearly three-quarters of a million Americans develop health care-associated infections each year, 75,000 of whom die during that hospitalization.

Other patients get the wrong medications, endure mistakes in surgery, experience falls in the hospital, receive treatments meant for someone else, develop pressure ulcers, and more. More than 12 million patients each year experience a diagnostic error in outpatient care, half of which could cause harm. One-third of Medicare beneficiaries in skilled nursing facilities experience adverse events.

“Crossing the Quality Chasm,” an influential report from the Institute of Medicine (now the National Academy of Medicine), says that “tens of thousands of Americans die each year from errors in their care, and hundreds of thousands suffer or barely escape from nonfatal injuries that a truly high-quality care system would largely prevent.”

There have been improvements in patient safety in recent years, but they have been limited and inconsistent. New safety systems, like surgical checklists and medication barcoding, have taken hold in some places. But they have inexplicably failed to gain traction elsewhere.

My daughter’s death compelled me to help find ways to make American health care safer. I’m now on the Advisory Board of the National Patient Safety Foundation (NPSF), which recently released a Call to Action that reframes the challenge of preventing health care harm as a public health crisis and proposes a national coordinated response.

The Call to Action looks to earlier efforts to tackle serious public health problems like smoking, highway accidents, and drunk driving. They had in common strong leadership, an actively engaged public, and new cultural norms. They have also paid off. Since 1965, the smoking rate has declined from 42% to 17%, the motor vehicle fatality rate decreased by half and the alcohol-related share of motor vehicle fatalities dropped from one-half to one-third.

The Call to Action aims to help improve patient safety by embracing the powerful combination of leadership, coordinated and clearly defined messages, and public engagement that has provided the foundation of successful public health campaigns. It stresses the need for collaboration among all stakeholders, especially patients and families.

The NPSF wants patients and families to share decision-making with their physicians and to play active roles when medical teams visit hospitalized patients at the bedside The foundation also calls for removing limits on family visiting hours, making available patient-activated rapid response teams, and participating in root cause analyses when harm or mistakes occur.

Here are a few other things that patients and family members can do to make each health care encounter safer.

• Wash your hands to prevent infection and don’t be shy about reminding others, especially the medical staff, to do the same thing.
• Ask questions about the risks and benefits of any treatment or procedure.
• Don’t go alone – bring a trusted ally with you whenever possible.
• Know your medications and why you’re taking them.
• Repeat back to your clinicians what you think they’ve told you.
• And understand your care plan by asking the NPSF Ask Me 3 questions: What is my main problem? What do I need to do? Why is it important for me to do this?

Coordinated efforts to improve patient safety can pay off. Take controlling health care-associated infections as an example. In 2008, the US Department of Health and Human Services and the Centers for Disease Control and Prevention established a federal steering committee, followed the next year by a national action plan, for reducing these largely preventable infections. Using a population-focused, public health approach, this effort has led to a 50 percent decrease in central line infections.

As a nation of patients, we must make patient safety a priority. Each of us should put the “public” in public health and work to prevent health care harm in every way possible.

Stephen E. Littlejohn is a member of the board of advisors of the National Patient Safety Foundation.