Understanding medical error and improving patient safety in the inpatient setting

Since the publication in 1999 of the Institute of Medicine (IOM) report To Err Is Human [1], medical error and patient safety have become major concerns of the general public, state, and federal agencies. The IOM report highlighted the risks of medical care in the United States and shocked many Americans, especially with its estimate that medical errors result in 44,000 to 98,000 hospital deaths per year. This particular estimate of the mortality attributable to medical error-one that surpasses estimates of deaths due to breast cancer, motor vehicle accidents, and HIV infection-may overstate the impact of medical errors [2-4]. Nonetheless, few would doubt that health care has paid far less attention to error and safety than have other comparable industries [5]. Thus, regardless of the precise morbidity and mortality attributable to medical error, the current interest in patient safety is long overdue. For physicians practicing in the hospital setting, this interest represents an important opportunity to improve the care of individual patients, through increased awareness of the ways errors can occur and, for patients in general, to participate in quality improvement activities focusing on patient safety. This article reviews issues in patient safety related to the inpatient setting. The epidemiology of adverse events among hospitalized patients is examined, and some of the lessons health care providers can learn from other disciplines are reviewed as well. These include psychologic principles that emerge from the study of human error and techniques for responding to adverse events and serious errors. In addition, this article looks at findings from a recent review [6] of specific patient safety practices that complement the more general lessons related to an understanding of human error and techniques for the investigation of serious errors. By shifting the focus away from error and focusing simply on the occurrence of adverse events, it becomes clear that the clinical research literature furnishes a number of evidence-based practices that reduce complications of hospital care and thus improve patient safety.