AHRQ

Patient Safety Councils:
A New Tool for Patient Safety

By Carolyn M. Clancy, MD

Nearly 10 years after the Institute of Medicine’s To Err Is Human
report (2000) galvanized the national patient safety movement,
healthcare providers and organizations have re-tooled many of their
inpatient processes, systems, and training programs as they aim to
deliver safer medical care.

Letters

Is Heparin Therapy Outmoded?

Dager et al. offer expert, useful, and pertinent advice regarding safe use of heparin (“Heaparin: Improving Treatment and Reducing Risk of Harm,”
Jan/Feb 2009). They miss the salient opportunity to make an even
stronger case: heparin is outmoded therapy, and should be replaced by
use of low- and ultra-low molecular heparins (LMWHs), except perhaps in
certain circumstances. LMWHs have been used for more than 20 years in
Europe and have been approved for use in the United States since the
early 1990s.

Editor’s Notebook

PSQH Turns Five

By Susan Carr

With this issue, Patient Safety & Quality Healthcare (PSQH)
reaches its fifth anniversary, which prompts me to take a moment and
think about how much the world has changed and stayed the same in the
past five years. When we published the first issue, in July 2004, the
patient safety community was discussing how much progress—if any—had
been made since the IOM published To Err Is Human five years earlier, and now we are assessing progress made over the past 10 years.

The information technology (IT) plan in most hospitals is beginning to look like the wish list of your average American teenager — software, PDAs, wireless infrastructure. Healthcare is amidst a revolutionary game of catch-up when it comes to applying information technology to the business of patient care.

The demand for telephone interpreting (TI) services — and on-demand interpretation (ODI) in general — begins the moment a person enters a new language setting and cannot adequately communicate without outside support. Whether it is a patient trying to schedule an appointment with a doctor or an automobile accident victim dialing 9-1-1, interpreting services are critical to society, business, and government. As new arrivals pour into the United States, the influx of new languages fuels the demand for interpreting services.

The medical staff organization traditionally focuses on credentialing and peer review, primarily addressing physicians’ individual skills, qualifications, and practice patterns. Promoting quality and safety in healthcare today requires a break from this narrow focus into a more global view of processes and systems that are the significant determinants of outcomes. With this transformation, the physicians’ role in patient care is in transition.

Home use of medical equipment continues to grow, including both equipment expressly designed for the lay user and equipment adopted for home use but where the layman may not be the original intended user. Some of this equipment is rented to the home user directly and some through the insurer. Because of the increase in home use, there has been increasing attention to the design of this equipment with respect to its usability by non-professional users.

As the number of days that patients spend in the hospital continues to drop, the need for thoroughly planned and clearly explained post-hospital care has risen dramatically.

In 2006, the average hospital stay for patients of all ages was 4.8 days, compared with 7.5 days in 1980, according to government statistics (National Center for Health Statistics, 2007). The drop in hospital days has been even more dramatic for patients 65 years and older….

The American Reinvestment and Recovery Act 2009 (ARRA) earmarks more than $800 million toward research on comparative effectiveness of medical treatments. In addition, more than $700 million is directed to the Agency for Healthcare Research and Quality, a research institution with a long history of evaluating effectiveness of treatments. With healthcare reform at the top of the agenda for the 111th Congress and the Obama administration, will a NICE-like entity be part of the reform package?

My 20-something friend Colby observed recently that her younger brother unwittingly scares away girlfriends by jumping too quickly to the “define the relationship” conversation. I thought of Colby at a conference I attended in April, where the topic of changing roles for physicians and patients infused all proceedings. Rather than scaring people away, interest in “defining the relationship” packed the house.