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Political leaders are responding eagerly to the idea of mandatory reporting requirements as outlined in the recent report from the Institute of Medicine. The recent report lays out a comprehensive strategy for government, industry, consumers, and health providers to reduce medical errors, and it calls on Congress to create a national patient safety center to develop new tools and systems needed to address persistent problems.
The report estimates that medical errors kill at least 44,000 people in U.S. hospitals each year, and possibly as many as 98,000. Even using the lower estimate, more people die from medical mistakes each year than from highway accidents, breast cancer, or AIDS, says William Richardson, chair of the committee that wrote the report and president and chief executive officer of the W.K. Kellogg Foundation in Battle Creek, MI. While errors may be detected more easily in hospitals, they afflict every health care setting: day-surgery and outpatient clinics, retail pharmacies, nursing homes, and home care. Deaths from medication errors that take place both in and out of hospitals — more than 7,000 annually — exceed deaths from workplace injuries, the report says.
"These stunningly high rates of medical errors — resulting in deaths, permanent disability, and unnecessary suffering — are simply unacceptable in a medical system that promises first to do no harm,’" Richardson says. "Our recommendations are intended to encourage the health care system to take the actions necessary to improve safety. We must have a health care system that makes it easy to do things right and hard to do them wrong."
He says the technology and know-how exist to prevent many mistakes, so the committee sets as a minimum goal a 50% reduction in errors over the next five years. "We believe that with adequate leadership, attention, and resources, improve ments can be made. As we say in the report, It may be part of human nature to err, but it is also part of human nature to create solutions, find better alternatives, and meet the challenges ahead.’"
A work in four parts
To achieve a better safety record, the committee recommends a four-part plan designed to create both financial and regulatory incentives that will lead to a safer health care system. Taken together, these recommendations and findings represent a systematic way to design safety into the process of care, Richardson says. They should be evaluated after five years to assess progress in making the health system safer.
Citing examples from other industries, such as the airline industry, the committee says the health care industry needs a federal agency to ensure safety. The report says Congress should create a center for patient safety within the U.S. Depart ment of Health and Human Services (HHS). The center would set national safety goals, track progress in meeting them, and invest in research to learn more about preventing mistakes.
The center also would act as a clearinghouse, an objective source of the latest information on patient safety for the nation. For example, if a health care organization improves safety, its practices should be shared with a broad audience; the center, working with others, would help provide the needed channel.
Administratively, the center should be based in the HHS Agency for Healthcare Research and Quality, formerly the Agency for Health Care Policy and Research. Congress would need to spend $30 million to $35 million to set it up, the committee says, depending upon the kind of work the center would perform and on investments in issues of similar magnitude, as well as safety research by the public and private sectors. Funding would need to grow to at least $100 million annually, a little more than 1% of the estimated $8.8 billion spent each year as a result of medical errors that cause serious harm.
Businesses leap in
The committee defines "error" as the failure to complete a planned action as intended or the use of a wrong plan to achieve an aim, and it notes that not all errors result in harm. To learn about medical treatments that lead to serious injury or death and to prevent future occurrences, the committee recommends establishing a nationwide, mandatory public reporting system. Hospitals first, and eventually other places where patients get care, would be responsible for reporting such events to state governments. Currently, about a third of the states have mandatory reporting requirements.
The IOM report produced a quick response from leaders in business, not just health care, and from President Bill Clinton. Soon after the report was released, eight executives of some of the country’s biggest companies announced that they had formed an organization called the Leapfrog Group that will work to reduce medical errors, partly by putting pressure on health care providers and shunning those with high error rates. The health insurance provided by those employers is a strong economic incentive for the health care industry, they say, because employers will steer workers to those hospitals with the lowest error rates.
President Clinton has ordered federal health agencies to reduce the number of medical errors by 50% in five years. Three U.S. senators have announced they will begin hearings into medical errors early in 2000.