Why Can't Hospitals Avoid Simple Errors and Subsequent Patient Harm?

A recent article cited numerous cases in which significant errors were made in the same hospital (see Why Can’t Medicine Seem to Fix Simple Mistakes?). The question is raised why "medicine", in part specific hospitals, can't seem to prevent similar errors from happening. Below is an excerpt from it. It's lengthy, so read the whole thing if you are interested in the topic.

NYU's Langone Medical Center announced this week that it was adopting new procedures after the death of a 12-year old boy from septic shock. The hospital's emergency room sent Rory Staunton home in March and then failed to notify his doctor or family of lab results showing he was suffering from a raging infection.  In response to the case...,the hospital promised a bunch of basic fixes: ER doctors should be immediately notified of certain abnormal lab results and, if such results come in after a patient is sent home, the hospital should call the patient and his doctor....[S]adly, decades of experience covering such incidents suggest the medical system may prove resistant to change ....History suggests it would be a victory if NYU Langone manages to follow its own new rules as we all hope they will.  It's long been known that medical errors are a major problem.... Despite the resulting national focus on patient safety, patients continue to be harmed and killed by medical shortcuts, inadequate training and breakdowns in communication.  Unlike the airline industry, which relies on a safety net of checklists, the medical community has been slow to adopt them in all areas and often puts its faith in the outdated idea that doctors are infallible....Time and again, hospital officials have put in place solutions that seem ridiculously obvious.  And, inconceivably, the fixes are frequently ignored or ineffective.

Articles of this type often draw analogies between the airline industry and healthcare delivery in hospitals with the assumption that flight errors are rare. I don't want to categorize errors in hospitals as uncorrectable but the two settings are not really that comparable. Most plane flights last a relatively short time, the planes are staffed usually by a veteran crew, in-flight emergencies are the exception rather than the rule, and the customers normally just sit in their seats and are pacified by bags of peanuts. Hospitals and their staffs run around the clock, emergencies are common, the staff, although highly trained, keeps turning over, many of the staff such as interns and medical students are relatively untrained, the customer (i.e., the patient) is highly involved in all of the work processes, and it's hard to apply "standards" to the regimens of the individual patients.

I agree that checklists are important but this is only a band-aid on the larger problem. Medicine has always diagnosed and treated each patient in a semi-customized manner. This makes sense because it's often said that each patient is unique until a diagnosis and subsequent care is rendered. This one-off customization for each patient often leads to mistakes. What we need is a standardized approach to diagnosis and treatment. Consider a busy cardiology service that might insert dozens of coronary artery stents each day. The error rate here is extremely low because the volume and the similarity of cases is such that each is similar to amenable to a common set of procedures.

Given the randomness of patient intake in many hospitals, how does one achieve a similar standardization? Start with the idea that physicians and nurses are not infallible. Hence, we need to increase the development of computerized algorithms that allow rapid convergence on both a diagnosis and treatment plan with detailed guidance about how to proceed with each step. In the past, such an approach has been ridiculed as "cookbook" medicine and avoided. Moreover, the information systems and the algorithms historically have not been up to the task. Part of the problem has also been the "macho" culture of medicine that has basked in its own complexity. It's now time to move toward a more predictable, standardized method of diagnosing and treating patients. This will reduce errors and also reduce costs.

Comments

[Hospital Management]

Management of hospital plays very important role in hospital and patient relation.

[Grahame Grieve]

One very key difference between hospitals and airlines: if there is a safety concern, the airline automatically doesn't fly; if there is not profit, the airline doesn't fly. There is no safety downside to this. Healthcare is very different - it is a trade-off between safety risks, and profit is not pre-eminent