| Response Prepared to National Medical Errors Report|
Stanford is preparing for probable increased regulatory and public scrutiny following a November 1999 federal report on medical errors nationally, said Larry L. Smith, Stanford Hospital and Clinics' director of risk management.
Smith said he believes the first wave of regulation and enforcement will focus on medication errors.
"It's a tangible, easily recognizable problem that is being fueled by a proliferation of products, regimens and interactions," he said.
Another key area for increased regulation and enforcement is in the burgeoning outpatient arena, he predicted. The "medical system is shifting from inpatient to outpatient and home therapies, and we haven't even begun to look at the incidence of injury" in this growing arena, Smith said.
Smith, who spoke at the Deputy Chiefs / Medical Staff Task Force meeting on March 15, said that better, more timely identification and reporting of errors is essential at a time when the government and the public is calling for greater regulation of health care providers. Smith said he will work with the medical staff "to set strategic goals around identifying and preventing medical errors and making the issue a visible campaign in the organization." The Quality Improvement Steering Committee has been designated as the oversight body for error identification here. That committee is chaired by Chief Medical Officer Peter Gregory and its membership includes the chairs of Stanford's clinical departments.
(For another discussion of the medical error issue, see Chief of Staff Larry Shuer's Medical Staff Update column for March and staff President Marty Bronk's February column.)
One reason Smith predicted Congress will pass or at least consider medical error legislation in the coming year is that a widely publicized Institute of Medicine [IOM> report that pointed to medical errors as one of the nation's leading causes of death and injury. The report, released in November 1999, said Congress should establish a National Center for Patient Safety to develop new tools and new systems needed to address persistent patient safety issues. The report's authors, many of whom are prominent academic medical leaders, said the know-how exists to prevent many mistakes and that a realistic national goal is to reduce medical errors by at least 50 percent in five years.
The report cited two large studies, which found that adverse events - injuries resulting from a medical intervention - occurred in 2.9 percent of hospitalizations in Colorado and Utah and in 3.7 percent of hospitalizations in New York. In Colorado and Utah, 8.8 percent of the adverse events led to death, compared to 13.6 percent in New York, the report said.
"I can't imagine anyone on the Hill [Congress> voting against patient safety by not supporting a legislative response to the report that has come out of the Institute of Medicine," said Smith.
In addition, Smith said that President Clinton in February called for a far-reaching plan to reduce errors, including a requirement that hospitals participating in Medicare must implement error-reduction programs. Smith said he expects calls to heighten scrutiny of medical errors to continue, in part because of the politically intolerable perception that "we are sort of paying ourselves" for errors, since many patients require further, billable, medical treatment in response to medical errors.
Although institutions may find it difficult to find money to pay for new safety initiatives, Smith said Congress may be persuaded to help, since allocating money for patient safety is politically palatable.
"I think the government and third-party payers will become excited about the fact that there is money to be saved if we can reduce errors - the [IOM-reported> studies suggest very strongly that substantial money [$17 billion to $29 billion> could be saved if we didn't have these adverse events," he said.
Smith said all of this increased scrutiny and regulation might result in a greater sharing of information about errors, which could benefit institutions and their patients nationally if the information is constructively applied.
|โดย: jjxyz [15 ก.ค. 49 11:12] ( IP A:188.8.131.52 X: )|