Safety in Numbers

Dr. Schwartz

Patient safety organizations, commonly referred to as PSOs, are about to take off. And when they do, PSOs should provide hospitalists with invaluable data on improving patient safety.

“PSOs are a great concept, but even though it’s been around since 2005, I haven’t seen it clinically,” says Janet Nagamine, RN, MD, hospitalist at Kaiser Permanente in Santa Clara, Calif., and chair of SHM’s Hospital Quality and Patient Safety Committee.

This calendar year, Nagamine and the rest of hospital medicine should start to see some movement—“PSO 1.0,” if you will.

Background

PSOs are public and private organizations approved by the Agency for Healthcare Research and Quality (AHRQ); they include such groups as Health Watch Inc., Human Performance Technology Group, and the Institute for Safe Medication Practices, which will collect, aggregate, and analyze data on patient safety events. Hospitals and other healthcare providers will voluntarily and confidentially report data. The ultimate goal is to advance changes in culture, processes, and systems to enhance patient safety.

A hospitalist working in one hospital has only the information about events in that hospital, but 5,000 hospitals can provide more specific and actionable information.

PSOs grew out of the Patient Safety and Quality Improvement Act of 2005, which was a response to the Institute of Medicine’s landmark report “To Err Is Human: Building a Safer Health System.” But it wasn’t until last year that the U.S. Department of Health and Human Services issued a final rule outlining PSO requirements and procedures. The rule became effective Jan. 19, 2009.

AHRQ is responsible for coordinating the development of a set of common definitions and reporting formats, called common formats, for collecting the data. Eventually, AHRQ will create a network of patient safety databases to which PSOs, providers, and others can voluntarily contribute non-identifiable patient safety information. This network will serve as an interactive evidence-based management resource for providers, PSOs, and other entities. AHRQ will use data from the network to analyze national and regional statistics regarding patient safety events. Findings will be made public and will be included in AHRQ’s annual National Healthcare Quality Report.

Public Policy Points

Primary Care Matters

American primary care is critically important to providing patients with better outcomes at lower costs, as confirmed by a white paper released by the American College of Physicians (ACP). “How Is a Shortage of Primary Care Physicians Affecting the Quality and Cost of Medical Care?” reviews 20 years of research and documents the value of primary care. The white paper outlines more than 100 studies, providing an overview of current trends in the primary-care-physician workforce, the importance and value of primary care, and the growing demand for primary-care services in the U.S. Download the white paper.

Resident Duty Hours Reduced Again?

A report released by the Institute of Medicine (IOM) in December recommends further restrictions on resident duty hours. Although the report encourages sticking with the current 80-hour workweek, it suggests limiting residents to 16-hour shifts, including a mandatory five-hour sleep break, and providing continuous and immediate access to an in-house supervising physician. The recommendation even calls for providing transportation home in case a resident is too tired to drive safely. Read the report .

Pennsylvania Hospitals Sue for Malpractice Money

The Hospital and Health System Association of Pennsylvania filed a lawsuit Dec. 11 alleging the administration of Gov. Ed Rendell violated the state’s constitution by failing to provide funding for Mcare, a program designed to help subsidize medical malpractice insurance costs for doctors. The suit says the state owes doctors and other providers between $446 million and $616 million in reimbursements for bills paid into the malpractice fund. Funding for the Mcare program comes from a state tobacco tax. The suit requests Mcare be fully funded by the state; Gov. Rendell has stated he would not reinstate full funding until the legislature acts on his proposal to expand affordable health coverage to more state residents.