American patient safety experts, Robert Wachter and Peter Pronovost wrote in this week’s NEJM that failure to hold clinicians accountable for patient safety is the main reason medical errors continue to happen in hospitals.
They said that the estimated 100,000 yearly deaths from healthcare-associated infections in the US “could be prevented by strict adherence to infection-control practices including hand hygiene”. In most hospitals in the US, hand-hygiene rates are between 30% and 70%, other safety practices such as using a checklist to reduce bloodstream infection, marking the surgical site to prevent wrong-site surgery and performing a preoperative “time-out” are frequently skipped by physicians.
The authors noted that 4000 wrong-site surgeries still occur each year in the US, but hospitals have been reluctant to punish the persistent offenders for financial reasons. They said that the tradition of weak enforcement of safety rules has led too many physicians to ignore them.
In many American hospitals, physicians can lose their staff privileges for failing to sign discharge summaries or operative notes, this is prompted by regulatory and financial requirements rather than patient safety.
The authors called for penalties on doctors and nurses who repeatedly fail to comply with patient safety measures in parallel with the “no blame” approach embraced by many healthcare providers.
They listed some suggested penalties for failure to adhere to safety practice, for example, healthcare workers who persistently fail the hand hygiene, would be required to undergo training and re-education and lose their staff privileges and loss of pay for a week. Repeated failings by surgeons to conduct a “time-out” prior to surgery would result in loss of access to the operating rooms for 2 weeks with loss of pay. Repeated failure to use and sign surgical lists when inserting catheters would be similarly punished.
Pronovost said finding a workable balance between no blame and individual accountability will be challenging but the right balance will save lives.
Source: "Balancing "No Blame" with Accountability in Patient Safety". NEJM 2009, 361(14):1401-1406
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