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Lucian Leape Discusses Steps to Achieve Flawless Patient Care

By Sasha Bartolf, CQ Staff

October 9, 2007 – Team training, the use of trigger tools, and effective accountability systems are keys to attaining flawless patient care—and more people are recognizing this, according to Lucian Leape, one of the nation's leading figures in patient safety and an adjunct professor of health policy at the Harvard School of Public Health.

Now "we can use perfection as a benchmark," Leape said during an interview released Tuesday by the journal Health Affairs. In the discussion, Leape addressed ways to improve patient care and safety, as well as the new methods doctors and hospitals are implementing to eliminate medical errors and injuries.

A landmark 1999 Institute of Medicine study stated that medical errors kill up to 99,000 U.S. hospital patients per year, prompting calls throughout the medical community and on Capitol Hill to find ways to prevent errors and improve patient care.

Among his recommendations, Leape said he advocates intensive team training and simulation training programs as being critical to reducing patient errors. While he acknowledged that simulation training is expensive, "everyone likes the idea of doctors, nurses, and anesthetists experiencing their first crisis on a plastic patient" rather than on a real one, he said.

Leape also said he believed that greater integration between nurses, doctors, and pharmacists is essential. "At a minimum, in the first year of medical school, all nurses, doctors, and pharmacists should learn the basics of error theory" and have experience working together in "clinical problem-solving exercises" while in school.

Leape pointed to "convincing demonstrations" at such places as The John Hopkins Hospital's intensive care unit as well as 68 hospitals in Michigan where central-line infections and ventilator-assisted pneumonia were abated. "If 68 hospitals in Michigan can receive these results, then so can all 5,000 hospitals in the United States," he said. In both cases, the medical teams had specific protocols that were rigidly enforced to ensure things were done right, Leape said.

In addition, a "trigger tool"—a list of 50 "elements" that help alert a doctor to whether or not a test result or a patient's experiences with a drug are abnormal, also is an effective way to reduce adverse events for patients, Leape said. "This is a list . . . that can be found in the patient record, many of them laboratory tests or simple clinical observations," he said. "You identify abnormal findings and investigate whether a patient has suffered an adverse event." The Institute for Healthcare Improvement (IHI), which developed the trigger tool, estimates there are 15 million preventable injuries per year, which translates into roughly 40 percent of all patients experiencing some sort of injury while receiving medical care.

Acknowledging mistakes in patient safety and providing full disclosure and compensation to patients is another concept Leape said he supported. He said fear of litigation is most often why patients do not learn the truth behind their accidental injuries but that studies conducted by the University of Michigan and liability insurers are proving that full disclosure and apologies to patients have led to substantial reductions in the number of suits filed.

In terms of the barriers to better patient care, Leape faults hospital administrators and CEOs for their lack of interest in investing in better care for patients. The "single most disappointing aspect of the safety movement" has been "the difficulty in getting CEOs of hospitals and health care systems to make safety a priority," Leape said.

He also criticized federal and state governments for not doing enough to reduce the number of deaths and infections as a result of being admitted into a hospital. "The federal government has not done much to provide incentives, financial or other, to improve safety." While some states have established reporting systems, just collecting information is not a very powerful factor for change, he said.

Leape did applaud efforts by a number of states to require hospitals to publicly report data about the care they offer, including the number of medical errors and injuries that occur each year. By making this data public, the media can report what is being done, both good and bad, in the patient safety arena.

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