Why a Special Issue on Patient Safety?

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Patient Safety: A Special Issue -- January 2005  

By John C. Jennings, MD
Texas Medicine Editorial Board  

Nothing is new about the medical profession's concern for patient safety. Our profession's profession has always been to provide the best possible care and best outcome for every patient. Recent publications, including a controversial report from the Institute of Medicine, have estimated that as many as 98,000 patients die each year because of medical errors. The methodology that produced these estimates has been questioned, but whatever the true number might be, any preventable death should concern physicians. The "shock effect" of such a high projection of in-hospital errors and deaths has made the topic of patient safety a high-level concern of health care leaders and lawmakers.

The challenge of ensuring safety in health care is unique. Comparing health care delivery with other types of service industries can be difficult or even inappropriate. However, the basic quality assurance and improvement processes that have been employed elsewhere do apply to the practice of medicine. Caring for injured or diseased human beings severely limits the utility of some of the most successful safety procedures of other industries.

For example, airlines have introduced universal methods that are proven to increase safety for its passengers. Preventive maintenance, periodic inspections, targeted training, and enforced accountability are all mandated for any company that flies an airplane. In contrast, human beings can choose not to seek preventive care even when it is readily available. We can choose to participate in habits and activities that are hazardous to our health. People can neglect to have periodic health screening and examinations. People can even neglect responsibility for their own health and expect the health care system to be accountable instead.

An airline can ground a plane for the slightest malfunction and replace a part that will be as good as new. Physicians are obligated to take care of patients in the worst of conditions and "fly" with them until the patients either "land" and get better or "crash" and die. No airline would intentionally operate its planes this way.

In health care and in all industries, human errors are more likely to occur in emergency situations. Critically injured and acutely ill patients create emergencies in hospitals that inevitably increase risk for error. Despite this lack of direct analogy to other industries, physicians and all providers of health care have a great opportunity to learn and apply new methodology to improve patient safety.

This issue of Texas Medicine is an effort to inform all interested persons in our state about what the medical profession is already doing and what it can do additionally to impact patient safety. We have identified and solicited the commentary and expertise of the foremost advocates of patient safety in Texas. The investigative work of our Texas Medical Association staff over a broad range of topics has been condensed into articles that we anticipate will be interesting and valuable for TMA members and all of our readers. And, we are pleased to offer 2 hours of continuing medical education credit in ethics for reading this issue and completing a quiz and self-assessment form.

Dr. Jennings is professor and residency program director in the Department of Obstetrics and Gynecology at The University of Texas Medical Branch at Galveston.