Preventing Patient Harm

Seeing It Through: Confronting the Danger of Missed Blood Clot Prophylaxis

Seeing It Through: Confronting the Danger of Missed Blood Clot Prophylaxis

Posted by  | Patient-Centered Care, Preventing Patient Harm

- By Elliott Haut and Brandyn Lau on behalf of the Johns Hopkins Venous Thromboembolism Collaborative You pack a healthy lunch for your child, but the carrot sticks and apple come home untouched. You donate to disaster relief, but the supplies sit unused in a shipping container. You mail a birthday gift to a friend,(...)

Read More

A New Focus — and Journal — at the Intersection of Patient Safety, Legal and Risk

A New Focus — and Journal — at the Intersection of Patient Safety, Legal and Risk

Posted by  | Preventing Patient Harm

In 2009, Erlanger Health System in Chattanooga, Tenn. upended the classic "deny and defend" approach to fighting malpractice lawsuits and instituted a communication-and-resolution program. In this system, when the hospital determines that it made an error, it apologizes to the patient or family members and commits to changes to reduce the chances of similar events(...)

Read More

The Psychology Behind Antibiotic Misuse

The Psychology Behind Antibiotic Misuse

Posted by  | Organizational and Cultural Change, Preventing Patient Harm

None of us wants to live in a world without access to lifesaving antibiotics. No patient should be subject to an allergic reaction or organ dysfunction from these drugs. No one wants to contract a potentially deadly form of diarrhea, claiming roughly 30,000 lives a year in the U.S., that can take hold after antibiotics wipe out(...)

Read More

Blockbuster Data: How Reporting Surgical Volumes Could Save Lives

Blockbuster Data: How Reporting Surgical Volumes Could Save Lives

Posted by  | Measurement of Safety and Quality, Preventing Patient Harm

If there was a wonder drug to save the lives of infants with serious heart abnormalities, doctors would be sure to prescribe it. Parents would insist that their children get it. The company that invented it would get rich. But there already is something that can have as dramatic an impact on these young lives(...)

Read More

Supporting ‘Second Victims’ Also Helps Hospital Budgets

Supporting ‘Second Victims’ Also Helps Hospital Budgets

Posted by  | Organizational and Cultural Change, Preventing Patient Harm

Saving their hospital nearly $2 million a year wasn't the goal for Albert Wu and Cheryl Connors when they created a program to support traumatized colleagues. Wu, a physician and health services researcher, and Connors, a patient safety specialist from a nursing background, were responding to a human need: Health care professionals too often had to(...)

Read More

Hospitals Helping Hospitals Improve Patient Safety

Hospitals Helping Hospitals Improve Patient Safety

Posted by  | Organizational and Cultural Change, Preventing Patient Harm

The moment that an accreditation team shows up unannounced can spike the pulse of even the most seasoned hospital executive. The next several days will amount to one big exam for the safety and quality of care, as surveyors meet with executives, managers and care teams, and watch first-hand as care is delivered. Make the(...)

Read More

How We Can Engineer a Less Costly Health Care System

How We Can Engineer a Less Costly Health Care System

Posted by  | Designing Safer Systems, Patient-Centered Care, Preventing Patient Harm

If we want to rein in the costs of the U.S. health-care system — now equal to nearly 18 percent of the nation's gross domestic product — we cannot ignore the fragmented technologies used to help heal and save lives. At first glance, the devices, monitors, electronic health records and machines found in today's hospitals(...)

Read More

Common Symptoms, Uncommon Causes: Reducing Misdiagnosis on the Front Lines

Common Symptoms, Uncommon Causes: Reducing Misdiagnosis on the Front Lines

Posted by  | Preventing Patient Harm

In 2013, a 52-year-old man went to an emergency department complaining of dizziness. Physicians evaluated him, decided that it was a benign condition — as it usually is — and sent him home. Days later, it became apparent that this was no harmless event. He suffered a significant stroke, with permanent disability as the result.(...)

Read More

Thinking Outside the Hospital: A Call to Action for Outpatient Safety

Thinking Outside the Hospital: A Call to Action for Outpatient Safety

Posted by  | Patient-Centered Care, Preventing Patient Harm

Health care has been thinking about medical errors for nearly 20 years, starting with the Institute of Medicine’s 1999 report “To Err is Human.” This and other work across the country have correctly shed light upon such medical errors as amputation of the wrong limb, inpatient adverse drug events and hospital-acquired infections, and we have(...)

Read More