Many hospitals not close to IOM goals

Nearly 9% of hospitals have no patient safety systems plan, according to recent research suggesting that risk managers need to reevaluate how they are striving to meet the Institute of Medicine safety goals.

Hospitals' development and implementation of patient safety systems is "at best modest," according to the study.1 (To see an abstract of the study, go to abstract/294/22/2858?etoc.)

Daniel Longo, OblSB, ScD, a researcher in the department of family and community medicine at the University of Missouri-Colombia School of Medicine, and fellow researchers assessed the status of hospital patient safety systems in Missouri and Utah in 2002 and again in 2004 to see whether the hospitals had worked to improve patient safety by focusing on the "systems' necessary to facilitate and enhance quality and protect patients" rather than focusing on individual errors. Quality and risk managers responded to a 91-question survey on computerized physician order entry (CPOE) systems, specific patient safety policies, drug storage and administration, adverse event/error reporting, and more.

The surveys revealed that 74% of hospitals had fully implemented a written patient safety plan, but nearly 9% reported no plan. Surgery appeared to have the greatest level of patient safety systems, according to the study.

"Data are consistent with recent reports that patient safety system progress is slow and is a cause for great concern," according to the researchers. "Efforts for improvement must be accelerated."

Longo says progress has been modest and risk managers must greatly accelerate efforts to comply with the IOM goals.

"Health care providers have not met the challenge laid out to them by the IOM, I think this makes hospitals very vulnerable from a risk management perspective," he says. "Risk managers should demand a budget for these improvements and the leverage is that these goals have been out there a while, other hospitals are meeting them, and if you're not meeting them, you're opening yourself up to all sorts of criticism that you knew these changes should be made but did nothing."

Longo goes so far as to say risk managers should stand their ground and not accept a response of "no" from upper management. "If they are resistant to making these changes, I as a risk manager would look for employment elsewhere," he says. "Risk managers should not put themselves in the position of working for an organization that says it supports safety but will not put their money where their mouth is."

Longo's research should be of concern to risk managers, says David Bates, MD, a member of the executive committee for the Center of Information Technology Leadership at Partners Healthcare System in Boston, chief of the division of general medicine at the Brigham and Women's Hospital in Boston, and professor of medicine at Harvard Medical School, also in Boston. He notes that the study was conducted in only two states and therefore might not be representative of the entire country, but he says he suspects nationwide results would be similar.

"The research confirms that there is a lot of room for improvement," he says. "The practices described in this report represent a to-do list for hospitals. Risk managers would do well to ask themselves how they would have responded to the same questions and what they are doing to meet these goals."


1. Longo DR, Hewett JE, Ge B, et al. The long road to patient safety: A status report on patient safety systems. JAMA 2005; 294:2,858-2,865.