Six years after a seminal Institute of Medicine report on patient safety, hospital patient-safety systems still don't come close to meeting IOM recommendations, according to a study in the i>Journal of the American Medical Association.
"Data are consistent with recent reports that patient-safety system progress is slow and (it) is a cause for great concern," the Dec. 14 report concluded. "Efforts for improvement must be accelerated."
The study measured variables that researchers and hospital officials in the surveyed facilities deemed most important to patient safety. Researchers at the University of Missouri at Columbia's School of Medicine based their conclusions on responses to a survey completed at 107 hospitals in Missouri and Utah in 2002 and again in 2004.
Some good news in the report: The data point to increases over time in policies for the voluntary reporting of errors, which were up from 60.9% of hospitals surveyed in 2002 to 69.9% in 2004.
But while 33% of hospitals surveyed in 2002 indicated they had a fully implemented computerized physician-order entry system for medications, by 2004 that number had increased to just 34%, according to the report by a research team headed by Daniel Longo, professor of family and community medicine and journalism at Missouri.
"Given computer technology growth in general and in hospital billing systems, it is disappointing to find such a high percentage of hospitals reporting no CPOE systems," Longo said in an interview. CPOE adoption rates nationally are generally considered to be much lower than the numbers in the University of Missouri survey and are more in the range of about 4% of hospitals.
In an interview, Longo said his survey's CPOE numbers were skewed upward because Utah has been a pioneer in the use of clinical information technology. The minuscule rate of change for CPOE from 2002 to 2004, however, was disappointing, Longo said, as were many of the other results.
The bottom line, he said, was that "We're not responding as an industry to the IOM study, and that's something we have to take seriously."
Longo said during the development of the survey questionnaire, its growing length concerned researchers that the response rate would suffer, and a 91-question survey emerged. "We asked (focus groups) what components you had to have to have a good patient-safety program. They said these questions are vital," Longo said.
Response rates were 76.8% of the hospitals surveyed in 2002 and 78% in 2004. Data were collected for each variable and also gathered into seven categories: use of CPOE systems, computerized test results and assessments of adverse effects; specific patient-safety policies; use of data in patient-safety programs; drug storage, administration and safety procedures; the manner of handling adverse-event or error reporting; prevention policies; and root cause analysis.
Longo said he found comfort in the relatively high patient-safety scores for surgical care. Also, there was "great improvement" in the number of hospitals that had fully implemented, written patient-safety plans, up from 55% in 2002 to 74.4% in 2004. But that also could be viewed as a glass more than one-fourth empty, according to Longo. "What about the other hospitals? Why don't they have a written policy?"
"That's why we say there is a lot more that needs to be done," Longo said.