Patient Safety: What Is Working and Why?
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Purpose of review
Our goal is to review a number of methodologies which have been used to improve safety in healthcare since the release of the Institute of Medicine report in 1998 which documented that error was a significant cause of mortality in the USA.
Multifaceted approaches have each led to reduction in error. Methods for error reduction included in this review are “Just Culture,” increased transparency and accountability, error reporting and investigation, second-victim programs, training in quality and safety methods, standardization and bundles, electronic health records, computerized order entry, barcode scanning, clinical decision support, predictive analytics, and situational awareness. Newer fields with the potential to improve patient safety include human factors engineering, indication-based prescribing, and Safety II.
While each intervention has led to incremental improvement, continued expansion of these programs is necessary to eliminate medical error.
KeywordsPatient safety Culture Event reporting Electronic health record Quality improvement Standardization
Institute of Medicine
Adverse drug event
Healthcare acquired infection
Central line-associated bloodstream infection
Surgical site infection
Catheter-associated urinary tract infection
Centers for Disease Control
Electronic health record
Health information technology
Computerized physician order entry
Health Information Technology for Economic and Clinical Health
Health Insurance Portability and Accountability Act
Clinical decision support
Intensive care unit
Rapid response team
Pediatric Early Warning Score
Human factors engineering
Systems Engineering Initiative for Patient Safety
Institute for Safe Medication Practices
Work as done
Work as imagined
Compliance with Ethical Standards
Conflict of Interest
Thomas Bartman, declares that he has no conflict of interest. C. Briana Bertoni declares that she has no conflict of interest. Jenna Merandi declares that she has no conflict of interest. Michael Brady declares that he has no conflict of interest. Ryan S. Bode declares that he has no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
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