Wednesday, June 27, 2012

The case for science-based training in patient safety and quality

Peter Pronovost and Myron Weisfeldt make the case in an article in the Annals of Internal Medicine for an expansion in science-based training in patient safety and quality.  That it should be necessary to have to make this case is indicative of a sorry lack of commitment in medical schools, residency programs, and funding agencies.

Nonetheless, it instructive to review their logic.  The authors first note that the public has benefited greatly from prior research investments in biomedical research.  Looking at diseases like AIDS, pediatric kidney cancer, adult kidney disease, orthopaedics, congestive heart failure, chronic myelogenous leukemia, and others, they point out that many people live longer and/or with better quality of life as a result of those funding commitments.

Then, they remind us of documented results from investments made in patient safety research and researchers.  They note that cite central line associated bloodstream infections cause nearly as many deaths as breast cancer each year in the US.  They show how this rate of disease can be reduced, citing the Michigan program, children's hospitals, and elsewhere where tens of thousands of cases were eliminated and where millions of dollars were saved.  But such efforts were possible only because people with an interest pieced together available time and funding from various sources and learned how to make this progress.  Those efforts have been exceptions:

The limited progress in reducing preventable harm during the last decade was, to a large extent, because the science underlying this field was dynamic, evolving, and had little funding.  However, the field too often sought quick fixes rather than a deeper understanding of whether an intervention worked and why, undertaking less robust evaluations, failing to partner with social scientists, and downplaying or being incognizant of the need for formal degree programs in patient safety research.  For example, sentinel events recur in spite of investigations; yet, human factors engineers are rarely involved in these investigations.

The authors note that funding that has existed for research training and research in this field has been substantially reduced:

Yet, these young researchers offer hope by enhancing health care value, reducing preventable harm, reducing health care costs, improving patient-reported outcomes, and ensuring that patients receive the best possible health care for the public's investment in them.

If as David Mayer suggests, we need to "educate the young and regulate the old," this is not the right time to cheap out on the education part of training in patient quality and safety research.


DK Berry said...

"and downplaying or being incognizant of the need for formal degree programs in patient safety research."

Really? A degree program in patient safety research? Honestly?

Seems like something an industrial engineer ought to be able to be able to provide relevant guidance with effective study, analysis, and process improvement and follow up.

Thing most relevant that is missing from the list: Failure of leadership to commit to an improvement objective and devotion resources to make it a reality and keep it there.

Anonymous said...

DK Berry took the words out of my mouth in the last sentence. Although one may quibble about the evidence supporting the effectiveness of one or another initiative, there is a simple, but imperative way for CEO's to get started NOW - set about changing the safety culture in your hospital. Unless you do that, all other efforts are for naught. Don't believe that? Check out Dr. Pronovost's published material on how those cultural changes must occur for checklists, for example, to be effective.