Readers know of my disdain for performance measurement. The problem with performance measurement starts with a focus on process, but has other major problems that I have written about incessantly. Performance measurement appeals to bureaucrats and bureaucracies. Recall Thomas Sowell’s quote, “You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing.”
But safety measurement does focus on outcomes. We still must have caution in understanding what harmful errors we can avoid and then learn how to minimize those errors. The “never event” idea is really only appropriate for a few issues, and should not be expanded beyond its rational boundaries.
We are not doing well on safety – Study Finds No Progress in Safety at Hospitals
Hospital safety has two major areas – the operating room and daily care. As an internist I do not know much about OR problems, but I do know about daily care problems. One of my colleagues specializes in hospital safety.
We have some “low hanging fruit”. We can greatly reduce medication errors through the use of computerized medical order entry. This does mean that physicians should write their orders directly into the computer. We know this works. Direct order entry removes several potential error potentials – poor handwriting, lost charts, clerk transcription errors. When properly constructed it also decreases the probability of wrong dosing. It speeds the delivery of the order to the pharmacy. The computer program can warn us of possible interaction problems.
We should be able to decrease some hospital acquired infections. The classic example is central line infections. We can decrease urinary catheter infections by removing unnecessary catheters.
Experts could give us more excellent examples, and I encourage readers to add to this discussion.
I challenge the “powers that be” to not confound performance measurement with safety. Safety should be a major focus of every hospital in the country.
Safety improvements require all members of the health care team to focus each day on safety. We should use well tested and documented checklists. We should use computer programs that show documented improvements. As physicians we must be flexible in changing how we do our work for our patients’ benefit. That does mean physician order entry directly into a computer. We have an obligation to our patients’ safety.