NQF: U.S. Health Care Not as Safe as It Should Be

According to the National Quality Forum, preventable errors cost the United States an estimated 98,000 lives and $17 billion to $29 billion per year in health care expenses, lost worker productivity, lost income, and disability. While health care spending grows more than 7 percent per year, it is estimated that patient safety is improving by only 1 percent, NQF says.

Despite dire statistics, the organization notes that there are pockets of improvement and steps patients and their doctors can take to help ensure they receive the safest care possible. In hospitals, clinics, and emergency rooms, patients and health care providers can use the NQF's endorsed list of 34 "best practices" to improve health care safety. The Practices -- covering areas like medication use, leadership, radiation safety, and health care-associated infections -- are downloadable at the NQF Web site, www.qualityforum.org.

The Safe Practices are evidence-based improvement strategies for those who provide, purchase, and use health care to ensure that harm is reduced and care is safe. They also are a guide for patients and their families to get involved to achieve safer care. Patients who are engaged as active partners in their health care team are vital to achieving better health outcomes and lower costs, notes NQF, offering the following advice:

  • Repeat in your own words. After your doctor tells you about a procedure, medications, symptoms, or other details about your care, repeat it to back to him or her in your own words.

Communication failures between patients and health care providers are at the root of systems failures and human errors that lead to harm. Ensuring you understand your diagnosis, treatment options, and upcoming procedures can help you make informed decisions about your care. (Safe Practice #5: Informed Consent)

  • Ask for your discharge plan. Before you leave the hospital ask your doctor if he or she has given a copy of your discharge plan to your primary care physician. Also ask your nurse or doctor for your own copy of your discharge plan. The plan should be as concise as possible and you and your primary care physician should understand the next steps in your care.

Transfer from a hospital to primary care or a community setting is often an unsystematic, fragmented process that creates high risk for adverse events. The lack of communication and coordination among care settings often puts patients at risk. The use of a hospital discharge plan has been shown to decrease re-hospitalization. (Safe Practice #15: Discharge Systems)

  • Keep a list of your medications. Ask your doctor for an accurate, up-to-date list of the medications you are taking. Keep it with you and present it to specialists, hospital physicians, and other health care professionals you visit.

An estimated 1.5 million preventable adverse drug events occur each year. A recent study showed 96 percent of patients failed to recall one or more of the medicines they had been prescribed during their hospital stay. Sharing your medication list with the hospital team can help prevent miscommunication and prescribing errors, and encourage that you leave the hospital with the right medications. (Safe Practice #17: Medication Reconciliation)

  • Ask your doctor to wash his/her hands. At the beginning of any exam or procedure, ask your doctor or other health care professional if he or she has washed his or her hands. When you're a patient or visitor in a health care facility, wash your hands or use hand sanitizer regularly.

Hand hygiene is one of the most important and effective interventions in preventing transmission of pathogens in health care facilities. However, some studies have observed a hand washing compliance rate of less than 50 percent. Patients can reduce the spread of pathogens by washing their own hands and asking health professionals to wash theirs. (Safe Practice #19: Hand Hygiene)

  • Get and keep your test results. If you've had a test done at a clinic or hospital, follow-up with your doctor to get the results and keep a copy for yourself.

Critical information about medical history, diagnostic test results, treatments, and procedures are often not communicated to everyone providing care for a patient. Even more common, such information is often not communicated among care settings. One study of diagnostic testing in primary care found approximately 25 percent of medical errors involve failures in reporting test results. Patients can help reduce errors by keeping copies of their test results and sharing them with their other care providers. (Safe Practice #12: Patient Care Information)

The evidence-based practices endorsed by the nonprofit NQF build on six years of work aimed at defining and refining strategies that improve the safety of health care. NQF recently updated the 34 Practices and the accompanying manual that outlines implementation strategies and guidance for involving patients and families in safe care. The Practices are part of the organization's ongoing work to improve safety in health care. NQF also endorses a list of Serious Reportable Events, or events that should never happen in health care such as wrong site surgery or leaving a foreign object in a patient during surgery. This list of Serious Reportable Events works in tandem with Safe Practices. By reporting serious events, the health care system can learn how to make care safer, NQF says.

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