T

he United States is a nation of patients. More than 300 million Americans — 95 percent of us — encounter the nation’s health care system at least once in the space of five years. It’s essential that every health care encounter is safe and free from harm. Sadly, that isn’t the case.

Our daughter, Meredith, died not from the cancer she had been so bravely fighting but from a health care-associated infection that should have been preventable and for which there was no effective antibiotic. Meredith isn’t an exception. The Centers for Disease Control and Prevention estimate that nearly three-quarters of a million Americans develop health care-associated infections each year, 75,000 of whom die during that hospitalization.

Other patients get the wrong medications, endure mistakes in surgery, experience falls in the hospital, receive treatments meant for someone else, develop pressure ulcers, and more. More than 12 million patients each year experience a diagnostic error in outpatient care, half of which could cause harm. One-third of Medicare beneficiaries in skilled nursing facilities experience adverse events.

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“Crossing the Quality Chasm,” an influential report from the Institute of Medicine (now the National Academy of Medicine), says that “tens of thousands of Americans die each year from errors in their care, and hundreds of thousands suffer or barely escape from nonfatal injuries that a truly high-quality care system would largely prevent.”

There have been improvements in patient safety in recent years, but they have been limited and inconsistent. New safety systems, like surgical checklists and medication barcoding, have taken hold in some places. But they have inexplicably failed to gain traction elsewhere.

My daughter’s death compelled me to help find ways to make American health care safer. I’m now on the Advisory Board of the National Patient Safety Foundation (NPSF), which recently released a Call to Action that reframes the challenge of preventing health care harm as a public health crisis and proposes a national coordinated response.

The Call to Action looks to earlier efforts to tackle serious public health problems like smoking, highway accidents, and drunk driving. They had in common strong leadership, an actively engaged public, and new cultural norms. They have also paid off. Since 1965, the smoking rate has declined from 42% to 17%, the motor vehicle fatality rate decreased by half and the alcohol-related share of motor vehicle fatalities dropped from one-half to one-third.

The Call to Action aims to help improve patient safety by embracing the powerful combination of leadership, coordinated and clearly defined messages, and public engagement that has provided the foundation of successful public health campaigns. It stresses the need for collaboration among all stakeholders, especially patients and families.

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The NPSF wants patients and families to share decision-making with their physicians and to play active roles when medical teams visit hospitalized patients at the bedside The foundation also calls for removing limits on family visiting hours, making available patient-activated rapid response teams, and participating in root cause analyses when harm or mistakes occur.

Here are a few other things that patients and family members can do to make each health care encounter safer.

  • Wash your hands to prevent infection and don’t be shy about reminding others, especially the medical staff, to do the same thing.
  • Ask questions about the risks and benefits of any treatment or procedure.
  • Don’t go alone – bring a trusted ally with you whenever possible.
  • Know your medications and why you’re taking them.
  • Repeat back to your clinicians what you think they’ve told you.
  • And understand your care plan by asking the NPSF Ask Me 3 questions: What is my main problem? What do I need to do? Why is it important for me to do this?

Coordinated efforts to improve patient safety can pay off. Take controlling health care-associated infections as an example. In 2008, the US Department of Health and Human Services and the Centers for Disease Control and Prevention established a federal steering committee, followed the next year by a national action plan, for reducing these largely preventable infections. Using a population-focused, public health approach, this effort has led to a 50 percent decrease in central line infections.

As a nation of patients, we must make patient safety a priority. Each of us should put the “public” in public health and work to prevent health care harm in every way possible.

Stephen E. Littlejohn is a member of the board of advisors of the National Patient Safety Foundation.

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  • Patients should understand the risks of unavoidable Health Care-associated infections (HAIs) and physicians should target fundamental changes of medical practices in order to effectively minimize HAIs. While the author does prove a point when arguing that improving communication between the patients and physicians can decrease HAIs, I think this approach can only create insignificant change. However, both patients and physicians can more successfully improve overall patient safety in the hospital through learning about the potential HAIs associated with the course of treatments and perfecting medical practices to minimize errors. The article fails to acknowledge factors that are considerably more fundamental than communication. The author’s approach would have been much more holistic if he is able to recognize and address the primary causes of HAIs.

    First of all, optimizing the best treatment is more important than giving the “correct” treatment in order to decrease Health Care-associated Infections. Patients need to realize that the risk of many HAIs are unavoidable for certain treatment methods, thus they can not simply solve the problem through effective communication (Greco et al., 2016). A lot of patients demand rushed treatments and advanced surgeries in order to quickly eradicate their diseases, expecting that no HAIs risk will be associated it with these more complicated treatments (Ashing-Giwa et al., 2014). However, they are naïve to have that expectation, because nothing is risk-free in the medical field. For example, if a patient has developed a modifiable heart condition, then he is facing two main treatment options – dramatically changing his lifestyle or undergo cardiac surgery. Obviously he will not get HAIs for sure if he decided to gradually improve his condition through changing his lifestyle. Yet, many patients still choose to undergo surgery because this method seems to be more straightforward and require less work from the patients’ point of view (Greco et al., 2016). Since more and more patients go for the shorter yet more complicated treatment method, HAIs risk and prevalence rate are bound to increase along with their selection. Therefore, communicating will not change anything until patients are more mindful of the associated HAIs risk of their desired treatments. Understanding those unavoidable risks, patients can optimize their course of treatment with the amount of risk they are willing to accept, rather than just thoughtlessly demand for what seems to be the “correct” treatment and later blame the physicians for the repercussions.

    In addition, physician should continuously perfect their practices in order to decrease Health Care-associated Infections. When complicated treatments become the only option for patients, physicians’ efforts should serve as the next step to decrease HAIs. According to research, some HAIs have been declining after the improvements of medical practice. For example, catheter-related bloodstream infection in the ICU decreased by 46% between 2008 and 2012 and surgical-site infections decreased over 30% (Greco et al., 2016). Therefore, hospitals should invest in developing more methods to minimize medical errors and infections. In fact, Vogues and Iacobucci have found that health care facilities can greatly reduce errors and the prevalence of HAIs by adopting the practice and processes of high-reliability organizations (HROs) (2016). HROs refers to organizations that are constantly error-free in their high-demand, complex, and stressful performance environments, such as nuclear power plants and aircraft carrier flight decks. If hospitals can learn from HROs’ operating mechanisms, then HAIs can be greatly reduced through fundamentally improving the quality of the facility and the care.

    HAIs can be decreased with patients’ increased awareness of their risks and physicians’ need to perfect their medical practices. The author should focus more on these practical and effective improvements, such as urging patients to choose safer alternatives and encouraging physicians to get more training, rather than overlooking the issue as merely caused by communication. Just like all practices, perfection is an almost impossible state to achieve. However, with these preventative measures, Health Care-associated Infections can be reduced significantly.

    • Although the above comment is well written, it exposes bias from the very beginning with the word “unavoidable.”

      Many healthcare organizations are redefining “unavoidable” and getting rid of HAI’s entirely. In the words of one of my clients “we used to think that there was an ‘acceptable complication rate’ that we would accept and move on from. Then we eradicated all catheter infections for 5 years in our cath lab and we started thinking about what other unfortunate results to we take for granted. Now we don’t accept anything as unavoidable.”

      All patients eventually die, and simple fact has twisted the practice of medicine over the years into something that is unrecognizable for people outside of healthcare. Zero harm efforts are paying clinical and financial gains across the health system, and the author of that comment should hope that they go to the right hospital when they require hospitalization, where the staff is trained on a systems approach that ruthlessly eliminates opportunities to fail. Patient survival depends on it. I know of a hospital that has not done an amputation in 3 years for catheter related problems after taking an open minded “what harm can we eliminate” approach. Before that the system was doing 8 amputations per year as their “expected rate.” I’m very sorry about the event that took the daughter of the author. The same kind of people that put a person on the moon are eradicating that type of event from healthcare and good riddance.

      Let’s not accept anything less as success, and see where that takes us.

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