Despite increased emphasis on patient safety, little
progress has been made in making hospitals
safer, says Johns Hopkins critical care specialist Peter
Pronovost. In an article in the Dec. 24 issue of
the Journal of the American Medical Association,
Pronovost identifies physician autonomy and a lack
of standardization of safety protocols as the culprits.
"It's been almost 10 years since the Institute of
Medicine published To Err Is Human, its
treatise on the need for increased patient safety
initiatives at hospitals," he says. "Yet we really
haven't made much progress." According to Pronovost, an
average hospitalized adult will receive
recommended therapy only 53 percent of the time. This
deficiency accounts, in part, for the nearly
100,000 patients who die each year in the United States
because of hospital error.
"Imagine — America has some of the best doctors
and medicine in the world," Pronovost says,
"yet we are only getting it right half of the time."
He says that improvements in patient safety must
incorporate three principles.
First, physicians must balance their autonomy with
team-based standardized care protocols.
Informed decisions based on using standardized protocols
will give physicians more time to spend on
difficult cases, in which standardization is less
Second, medical students and residents need to be
trained in this new approach so that instead
of being anonymous decision makers, they are fully
socialized in their roles as patient agents. They
should understand that outcomes of patient care are a
product of the systems and tools designed to
deliver that care. To enhance trust and foster effective
teamwork, students from different clinical
disciplines should train together.
Third, the process by which evidence-based standards
and protocols are developed should itself
be standardized and made clear. If physicians are to
surrender autonomy, evidence biases and
uncertainties regarding the risks, benefits and costs for
patients, clinicians and payers should be
made explicit. Groups developing such standards should
represent a diverse group of stakeholders
consisting of patients, physicians, methodologists,
regulators and payers in order to ensure that all
points of views are reflected in the final products.
"Gone are the days when a doctor was on his own
carrying all the tools of modern medicine in a
black leather bag," Pronovost says. "Today, much of care is
team-based, and the wealth of techniques
and wisdom is too much for one doctor to keep in his or her
head. Standardization and a move away
from physician autonomy will help guarantee that each
patient receives the best treatment available."