such as "Introduction", "Conclusion"..etc
August 25, 2009— Is it more urgent for
hospitals, doctors and nurses to focus resources on preventing the
thousands of falls that injure hospitalized patients each year, or to
home in on preventing rare but dramatic instances of wrong-side
surgery? Is it best to concentrate immediately on preventing pediatric
medical errors or on preventing drug interactions in the elderly?
With efforts to improve patient safety gathering momentum, two Johns
Hopkins experts in patient safety and bioethics urge policy makers to
weigh in about which safety interventions deserve the most urgent
attention when it's clear that resources are limited.
In a commentary in the August 26 issue of the Journal of the American Medical Association
(JAMA), they suggest that health policy makers have yet to come to
grips with the complexity of setting such priorities, and that time is
of the essence.
"The importance of patient safety to people's lives and the quality
of health care is clear, but there aren't enough resources to devote to
everything simultaneously," says Ruth R. Faden, M.P.H., Ph.D.,
executive director of the Johns Hopkins Berman Institute of Bioethics.
Faden coauthored the JAMA commentary with award-winning Johns Hopkins
patient safety expert Peter J. Pronovost, M.D., M.P.H., a professor in
the Departments of Anesthesiology and Critical Care Medicine and
Surgery and director of Johns Hopkins Quality and Safety Research Group.
Noting that many patient safety interventions are patterned after
safety efforts in commercial aviation, Pronovost—whose "cockpit" style
checklists for intensive care unit personnel are one example—points out
that deciding patient safety priorities is infinitely more complicated
than similar efforts to protect passenger safety.
Aviation safety is almost solely focused on a single goal—preventing
death, Pronovost says—while patient safety involves a variety of
technologies, treatment risks, judgments and possible outcomes in
"While we're literally all in the same plane with aviation safety,
the concerns are very different in healthcare," he says. "You have
different kinds of patients in different settings, facing different
risks from errors and mistakes," he adds.
Among the social, ethical, scientific and political factors policy
makers should consider, the Hopkins pair write, are whether to give
priority to medical errors that are rare, devastating and likely to
involve individual culpability in a limited setting—like wrong side
surgery—or to more frequent, systemic problems—like falls—that are more
When resources are strained, policy makers need to consider tough
choices, such as whether to give more focus to safety issues involving
those with a good prognosis rather than to those in which survival from
the underlying illness is unlikely.
Fundamentally, they say, informed public policy requires open debate
about criteria for setting priorities in the first place. "Choosing
patient safety priorities will mean tradeoffs, and policy makers should
opt for a transparent, accountable, and ethical framework to set
decisions," Faden says.
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