Re-engineering how care is delivered to provide safer, more compassionate care

One of the most pressing issues in health care today is the quality and safety of the care that is delivered. Each year, millions of people suffer from medical errors and more than 400,000 die from these errors – making it the third leading cause of death in the U.S. following heart disease and cancer. Medical errors are numerous and varied – from infections to falls – and their causes equally diverse. But medical errors are not the only concern in safety. Diagnostic errors also affect a large number of people and these errors persist throughout all types of care settings.

Through our patient safety exploration, our goal is to identify where our resources can best be applied to address safety issues that currently plague our health care system, while striving to improve the experience and outcomes of patient care. Our focus in this area originates from our co-founder, Betty Irene Moore. Based on her personal experience in the hospital, and in caring for family members who have been hospitalized, she saw an opportunity to improve the quality and safety of care delivered in the San Francisco Bay Area.

More recently, we have funded work addressing safety issues, and also the practice and delivery of patient-centered care, in the intensive care unit. We selected the ICU because it is one of the most complex and costly settings in health care and it is a place where there is significant risk of experiencing harm. Our current ICU work is a partnership with four academic medical centers: Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, Johns Hopkins Medical Center and University of California, San Francisco Medical Center. Each center is focused on eliminating some of the more prevalent, and preventable, medical harms experienced in the ICU, along with ensuring delivery of patient-centered care. We are now considering how best to spread the successes and learnings from this project to ICUs nationwide and to other care settings, as appropriate.

To help determine our future focus in the safety area, we are currently exploring errors of diagnosis, avoidable harms that occur in community-based settings and safety issues that result from the introduction of health information technology. Most people will experience a diagnostic error in their lifetime. This means a diagnosis that is not accurate if it differs from the true condition or if it is an incomplete or imprecise diagnosis. Equally important, and as noted in the Institute of Medicine’s report Improving Diagnosis in Health Care, is the failure to establish an accurate and timely explanation of the health problem or to communicate that explanation to the patient. Additionally, the delivery of care is shifting to community-based settings, such as a rehabilitation center or a person’s home, which have not had the same level of attention as hospitals. This presents an important opportunity to increase collaboration and coordination of care within these different settings to address avoidable harms and diagnostic errors and improve patient experiences and outcomes. Lastly, the rapid pace of adopting new information technology which offers great promise to improve safety, also comes with unintended consequences. For example, excessive use of alerts may lead to alert fatigue, where clinicians fail to pay attention to the alerts that really matter; and poorly designed screens may result in inappropriate orders.

 

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