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U.S. health care system needs to be reengineered to improve patient safety, says UH doc

The prevalence of medication errors nationwide illustrates the need for greater automation and uniform standards in healthcare, said University Hospital’s Dr. Peter Pronovost, who helped author a presidential study out this month on patient safety.

A presidential study out this month says America’s healthcare system is too decentralized to uniformly deliver patient care safely. University Hospital’s Dr. Peter Pronovost, who helped author the report as part of the President's Council of Advisors on Science and Technology's Working Group on Patient Safety, said having presidential buy-in and support for this effort is important.

“Patient safety has never had presidential level of attention or even close to that," he said. "It doesn't get enough attention for the magnitude of the problem. [This is the] first time we ever had a president really speak about patient safety.”

The plan calls for a White House official to lead reforms to have clear leadership at the highest levels of government, more timely performance measures that would provide more relevant indicators for change and systemic approaches to reform that apply across the country.

Pronovost, University Hospitals' chief quality and clinical transformation officer, said the transportation industry's approach to safety risks is especially instructive. The airline industry takes a systemic approach to addressing any errors, isolating the cause and then implementing industry-wide standards in design and function to eliminate those errors.

The results are striking as there has not been a fatality in U.S. commercial air flight since 2009 despite millions of flights since then, he said. By comparison, Pronovost said approximately one in four patients in the U.S. suffers some sort of harm.

"Imagine going into a restaurant and thinking, 'One in four times, I'm going to get food poisoning,'" Pronovost said. "We wouldn't accept that, and we shouldn't accept it and don't need to accept it in health care."

The prevalence of medication errors nationwide illustrates the need for greater automation and uniform standards in healthcare, he added.

“Medication errors are the most common of errors," Pronovost said. "They are about 40% of all those hospital harms and we still have nurses doing math to calculate doses of things. We could automate the complete medication delivery system, but we haven't.”

There's also a need for greater transparency regarding how frequently medical procedures are performed because the more commonly a procedure is undertaken, the lower the error rate, he said. Another way to ensure increased patient safety would be to tie accreditation for Medicare reimbursement to rates of medical harm, Pronovost added.

"One of the things that we put in this [report] was to expand those conditions of participation ... in Medicare, to say when the hospitals are reviewed, there will be a meeting with the hospital board chair and the hospital CEO to review their rates of these top causes of harm and what their plan to improve is," he said.

He hopes that along would increase accountability and move the needle.

Next President Joe Biden will need to issue a presidential decree to authorize the federal government to implement its recommendations, Pronovost said.

Stephen Langel is a health reporter with Ideastream Public Media's engaged journalism team.