Are hospitals any safer these days?

January 1, 2006

The start of a new year is an appropriate time to take a look at patient safety-a problem high on the list of needed health-care reforms ever since the Institute of Medicine issued a shocking report in 1999 on the toll that medical errors were taking on patients' lives and well being. According to a study published last month in JAMA, hospitalized patients are, indeed, safer than they were a few years ago, but the pace of improvement is agonizingly slow (JAMA 2005;294:2858).

The researchers drew conclusions from a comparison of 2002 and 2004 surveys at every acute care hospital in Missouri and Utah. The most arresting example of progress? Implementation of computerized physician order-entry (CPOE) systems, an improvement in hospital procedure that is widely accepted as crucial to improving patient safety. About two-thirds of respondents had such a system in place for ordering clinical laboratory tests or imaging studies in 2004-a somewhat reassuring figure, even though it is only a few percentage points higher than what was seen in the 2002 survey.

When it came to CPOE for prescription drugs, full implementation was far lower-reported by only 34% of respondents in 2004, or less than one percentage point of improvement over what was reported in 2002. What's more, even when such a prescribing system was in place, only 3% of hospitals surveyed required physicians to use it.