Doctor Wearing Gloves

Thousands of patients die each year as a result of diagnostic errors, communication errors, and other medical errors. Despite over a decade of research, improvement, and effort, wide-scale reductions in patient harm have been modest. However, the Agency for Healthcare Research and Quality (AHRQ) has recently identified the top 10 patient safety strategies that are ready for immediate use. According to Medscape, these strategies could dramatically enhance patient safety and save lives by reducing medication errors, bed sores, and healthcare-associated infections.

In 1999, the U.S. Institute of Medicine issued a report called “To Err is Human: Building a Safer Health System,” which resulted in increased awareness of medical errors and pushed for improvements in patient safety. Three years later, AHRQ identified 79 safety strategies in their report, “Making Health Care Safe: A Critical Analysis of Patient Safety Practices.” Although the evidence base for safety strategies has continued to grow, great challenges exist in taking these strategies to scale through health systems.

Dr. Paul G. Shekelle of the RAND Corporation, along with Dr. Robert Wachter of UCSF’s Division of Hospital Medicine and Dr. Peter Pronovost of Johns Hopkins University, conducted an evidence-based assessment of patient safety strategies (PSSs). Over the past four years, these safety experts identified the top 10 PSSs and 31 additional PSSs using the assessment and input from clinicians, researchers, and policymakers regarding the epidemiology of errors and preventable harms.

Each year, diagnostic errors result in between 44,000 and 80,000 deaths in the United States. Bed sores lead to approximately 68,000 deaths, and thousands more patients die each year as a result of communication errors or failure to receive evidence-based interventions. But there are challenges to finding the underlying causes of medical errors and strategies for reducing them.

Dr. Nancy Foster, vice president of quality and patient safety policy at the American Hospital Association, identifies these challenges: budget cuts affecting AHRQ research, rarity of some errors hindering determination of causes and solutions, and multiple causes underlying some errors, which necessitate use of bundled strategies.

Addressing these challenges could save tens of thousands of lives each year. Using the bundle recommended by AHRQ, the American Hospital Association reported that their Hospital Engagement Network of nearly 1600 hospitals had a 40 percent reduction in central line bloodstream infections.

Physicians and healthcare providers may find it difficult to determine which safety strategies to implement, as there are often increasingly long lists of ideas to help improve safety. However, AHRQ’s top 10 list provides clinicians and hospitals with a sound basis for integrating proven strategies into their day-to-day delivery of patient care and safety.

AHRQ’s Top 10 Patient Safety Strategies include the following:

  • preoperative and anesthesia checklists to reduce operative and postoperative events;
  • bundles including checklists to reduce septicemia associated with central lines;
  • catheter reminders, stop orders, nurse-initiated removal protocols, and other interventions to limit urinary catheter use;
  • bundles to prevent ventilator-associated pneumonia, including head-of-bed elevation, sedation vacations, oral care with chlorhexidine, and subglottic suctioning endotracheal tubes;
  • hand hygiene;
  • do-not-use list for hazardous abbreviations;
  • multicomponent interventions to help prevent pressure ulcers;
  • barrier precautions to reduce healthcare-associated infections;
  • central line placement guided by real-time ultrasonography; and
  • strategies to improve venous thromboembolism prophylaxis.

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