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Abstract
The 1999 report by the Institute of Medicine, To Err is Human: Building a Safer Health System, spurred much debate regarding the proposal of changes needed in the healthcare system. A number of national and private initiatives were developed to define the scope of the problem and to develop strategies for quality improvement. In this paper, medical errors and the quality problems in healthcare will be discussed with some of the causes of the problems and the obstacles in the solution of the problem of quality improvement in healthcare.
Unlike other countries, the United States publishes research in the medical journals on the quality of health care. ... This report, titled To Err is Human: Building a Safer Health System (1999), was based on two studies that were conducted in 1991 resulting in the statistics that between 44,000 and 98,000 people are killed each year from medical errors. The report also went into specific errors that were identified in the studies. Medication errors are thought to cause 7,000 deaths annually. The annual cost of medication errors is at least $2 billion. Total costs for preventable medical mistakes, including lost wages and extra health costs are estimated to be between $17 billion and $29 billion a year. Preventable mistakes in hospitals alone are thought to cost from 2% to 4% of national health expenditures. Hospital care alone is the fourth to the eighth largest cause of death in the United States. ... According to Berwick (2002), approximately fifteen months after the release of the report To Err is Human, another report titled Crossing the Quality Chasm was released and addressed the quality areas for improvements in six dimensions of health care performance: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. Berwick noted that the Quality Chasm report went a step further than the report To Err is Human did. It made clear that patient safety is part of the large picture, and it actually dealt with the entire spectrum of concerns about health care quality. ... The IOM called for a broad national effort in the development of safety programs in health care organizations, with intensified efforts by regulators, health care purchasers, and professional societies. Robinson, Hohmann, Rifkin, Topp, Gilroy, Pickard, and Anderson (2002) noted that since the release of the report, the Agency for Healthcare Research and Quality, the Quality Interagency Coordination Task Force, and the National Quality Forum were the leading agencies designated to coordinate research activity and implement standards for quality improvement. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (2002) also became involved in this mission to improve health care and implemented new patient safety standards and mandatory nonpunitive reporting of serious medical errors because of the IOM’s recommendation for confidential, voluntary reporting of injuries due to medical care. ... The IOM report also called for a more systematic approach to the prevention of injuries due to medical care. If not for any other reason, the release of these reports publicized to the nation that there are definite problems in health care today. ... felt that the Medical Practice Studies (MPS) that were used by the IOM to assess the impact of medical injury did not calculate “excess” mortality. ... A retrospective medical record
review study was used that failed to focus solely on medical errors, but included many bad outcomes, which may be due more to poor luck than mistakes. In my opinion, whether the number of fatalities was less than the IOM reported, it still warranted action to be taken to improve the quality of health care. ...
Hayward and Hofer (2001) conducted a study where physician reviewers were trained to assess medical records and identify medical errors documented in the care of patients who died at seven Department of Veterans Affairs (VA) medical centers. The reviewers were then asked to estimate the probability that these deaths would have been prevented by optimal medical care. The methods used were that a total of 4,198 patients died at the seven VA medical centers from 1995 to 1996. ... Reviewers were asked specific questions regarding the timeliness of diagnostic evaluation, was the patient’s death preventable by better quality of care, and rating the overall quality of medical care.
Approximate Word count = 3476
Approximate Pages = 13.9
(250 words per page double spaced)
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