Safety in Hospitals, A Literature Review:
by Anna Hollenbeck, BS, AA ,MSIV.
Introduction: Patient safety is an important factor in healthcare training. Following graduation, US medical students enter into residency programs in which they train for a variable number of years in a specialty field. These residency training programs may be directly associated with a major university. Teaching hospitals can be either major, having a high degree of affiliation with a training program, or minor. Community hospitals are typically unaffiliated with a single institution. Using information matched to insurance data, along with interview techniques and observational studies, researchers can investigate the effects of different factors on patient safety. Following below are summaries of several articles on this topic.
- An article published recently in the Journal of Graduate Medical Education explored the perception of resident physicians on patient safety.1 Resident physicians have a unique position in the process of healthcare delivery, being able to provide feedback as both practicing physicians and continuing learners. Significant factors affecting patient safety, as reported in this study, include “lack of information, common errors, volume and acuity of patient, and inadequate supervision.” A “functional, integrated system to improve communication” was identified by residents as most necessary to improve patient safety outcomes. Of note, residents identified the process of reporting safety issues as “burdensome” and an area of risk in itself. Thus, instruction in patient safety may be of benefit in increasing disclosure and reducing the occurrence of adverse events.
- Interestingly, an article published in JAMA reported a difference in mortality and readmission rate of hospitalized patients treated by female and male physicians. The study analyzed a random sample of roughly 1,500,000 hospitalizations and found that “female physicians had significantly lower mortality rates (adjusted mortality rate, 11.07% vs 11.49%) and readmission rates (adjusted readmission rate, 15.02% vs 15.57%) compared with those cared for by male physicians within the same hospital.” Prior studies have shown that clinical guidelines and evidence based medicine may be more likely to direct the practice habits of female physicians.
III. A different study assessing medication safety in an ICU setting before and after implementation of an EHR (electronic health record) found that implementation decreased the rate of error overall, but the frequency of certain error types was increased post-implementation within the stages of transcription and administration. At the interface of medicine and technology, better system design may ameliorate the frequency of human errors.3 Technology has the capacity to play a significant role in improving patient safety.
- Finally, of note, two different articles explored the effect of insurance type and hospital type, respectively, on patient safety. In the first study it was observed that complication rates were lower in privately insured patients undergoing total knee arthroplasty versus those admitted via medicare.4 Medical complications, surgical complication and mortality all were increased post-operatively in the Medicare population. In the second article, status as a major teaching hospital reduced patient mortality, thus suggesting an improved safety profile in those undergoing care in an academic center.5
Conclusion: Collectively these studies provide a sample of the diverse factors affecting patient safety. Improved communication, increased resident instruction, and innovations in technology can all improve quality of care. Characteristics of individual providers, insurance classification and setting of care should not adversely affect treatment and methods to reduce these effects should be investigated. Whether via analysis of “big data” or through alternate methods of inquiry, research on minimizing adverse outcomes in patient care demonstrates that safety may be the most effective form of insurance after all.
- http://journals.lww.com/journalpatientsafety/Abstract/publishahead/Medication_Safety_in _Two_Intensive_Care_Units_of_a.99526.aspx