Dr. Robert M. Wachter, a professor of medicine, chief of the medical service and chair of the patient safety committee at UCSF Medical Center, has been a central figure in educating the medical community and general public about pressing safety issues in healthcare institutions. Dr. Wachter has written prolifically on this topic, including the bestseller Internal Bleeding: The Truth Behind America’s Terrifying Epidemic of Medical Mistakes. He has discussed patient safety on CNN, NPR, and ABC’s Good Morning America, and been quoted in the New York Times, the Wall Street Journal, and Time, to name only a few. His new textbook, Understanding Patient Safety, will be published by McGraw-Hill in October 2007. Here, Dr. Wachter discusses the world of patient safety and healthcare.
What prompted you to write your book, Understanding Patient Safety, at this point in time?
I get asked all the time – by medical and nursing students, senior hospital administrators and board members, quality and risk managers – to recommend a lively, engaging and evidence-based introduction to the field of patient safety written with a clinical slant. I couldn’t find a book that fit the bill, so the time seemed right to write one.
What has had the biggest impact on patient safety in the last 5 years?
The first step was awareness. Beginning with the publication of the Institute of Medicine report on medical errors in 2000, we now recognize how serious the problem of medical errors is – how many people are harmed and killed each year from medical mistakes. We also have discovered that our old approach to errors – just try to be really, really careful – was hopelessly flawed. So I think the combination of increased attention and a new approach, known as “systems thinking,†has made the largest difference.
What is the most common medical error occurring in healthcare institutions today?
Most errors relate to poor communication, between doctors and other doctors, between doctors and patients, between nurses and pharmacists, you name it. These communication glitches result in medication errors, surgical errors, radiology errors, and more.
Have advances in medical technology helped to minimize or increase the number of medical mistakes?
Both. On the one hand, technology is helping to decrease errors, such as through the use of computerized medical records, computerized order entry, and bar coding. Even relatively simple technologies that we don’t think of as “safety†oriented – text paging, portable ultrasound for catheter insertion or drainage of fluid from the abdomen or thorax – are actually saving lives. On the other hand, technology has made medicine much more complex, and therefore created many new errors. MRI scans are spectacular, but we didn’t have to worry about tanks of oxygen being converted into potentially fatal projectiles before we had scanners with powerful magnets.
In your opinion, what is the most important step hospitalists can take to address patient safety?
After I coined the term “hospitalist†in a 1996 article, I worried that the field was becoming known as being largely focused on efficiency – cutting hospital length of stay and costs. I’m quite proud that the last decade has seen an increasing focus by hospitalists on patient safety and healthcare quality. Hospitalists have to serve as the orchestra conductors for sick inpatients, pulling all the information together to provide the highest quality, safest care. And then they have to focus like a laser on ensuring that there is no information “voltage drop†at the time of discharge.
What future trends do you see emerging in the realm of patient safety and medical errors?
Computerization has clearly reached the tipping point – within a decade, it will be very unusual to find a hospital or large doctors’ office that still relies on pen and paper. We’re finding that IT improves safety in many ways, but that we’ve introduced a whole slew of unanticipated consequences, including some new classes of errors. The recognition of the critical importance of culture in safety is another major trend, with lots of effort going into trying to improve teamwork and collaboration. Simulation is beginning to take off. More attention is being paid to the importance of a well rested, well trained workforce. The residency duty hour limits of 80 hours a week are only the start. And the increased public attention to medical errors is leading to much more public reporting. There are truly 1,000 flowers blooming when it comes to safety.
What can Program Directors do to enhance residents’ attention to issues of safety and quality?
As a former residency program director, I had my residents partly in mind when I wrote Understanding Patient Safety. I find that residents are incredibly interested in patient safety, and they appreciate being taught it in a case-based and engaging way. They are also great at coming up with solutions. Go into any teaching hospital and try to figure out which systems need improving. All you need to do is ask the residents and the nurses and you’re done. The trick is to give them the opportunities to tell us, and then the skills to help be part of the solution.
What does ACGME expect and look for in terms of patient safety and health quality?
There are new mandates, from ACGME and some of the certifying boards, for residents to become competent in systems-based approaches, such as those in patient safety. But institutions and programs are still trying to figure out how to teach this material to residents in ways that engage them and stick. I hope this book can be one helpful tool.
How are the specialty boards handling the issue of patient safety? Are we seeing more cases and questions related to the topic?
Yes, it is all of a piece – the accreditors of medical and nursing schools, of residencies, and of practicing specialties have all recognized how critical patient safety is, and are using all their levers to promote a deeper understanding of the topic among their stakeholders. We’ll see more and more questions on every type of certifying exam on issues of safety and quality.
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