Patient Safety and Quality Improvement: What is the Next Goal?

Rahul K. Shah, MD George Washington University School of Medicine Children’s National Medical Center, Washington, DC A start of a new academic year is ahead of us and I am preparing to orient new residents and fellows to our hospital’s safety culture. As I reflect on the lecture, I recall my orientation to internship, which lasted just long enough to sign my paperwork (without reading it) and get an ID badge. Orientations for current residents and fellows now take three to four days! Why? What are they learning that is so crucial that we attendings are left alone to care for our patients this first week of July? At our hospital, one of the first things trainees learn about is our safety culture. Interestingly, the boring parts of orientation were pushed back onto days three and four. Yes—days three and four. These poor residents and fellows have a week of orientation (excluding July 4th) prior to being set free in the hospitals. The first words many of the trainees hear are about the safety culture and the safety transformation. The last decade has brought about significant advancements and strides in improving patient safety and quality improvement. If you are dubious, simply look at our academy. Much of what we talk about, what we are concerned about being measured upon, and what our payment ultimately will depend upon are the quality of care we provide and how we demonstrate that the care is on par with the standard. Indeed, the orientation for the incoming residents and fellows made me ponder what are the next goals for the patient safety and quality improvement initiatives especially vis a vis our Academy membership. There is myriad data showing that quality improvement is needed in American healthcare and that such improvements have demonstrable improvement in the overall quality patients receive. My thoughts (and only mine, not the Academy’s or others) are that there will be three areas that much attention will be devoted toward as we embark upon a new year of interns, residents, and fellows. The use of big data to drive quality improvement will begin to take form. Indeed, the Global Tracheostomy Collaborative (see: http://globaltracheostomycollaborative.org/, which I am honored to be a part of) is one such example of using institutional datasets to improve the care of a specific condition on a macro-level (in a collaborative). There will be an emphasis on the role of the smaller group practices and the private physicians and how they can drive quality improvements (and measure such interventions). The majority of initiatives and studies in the last decade have disproportionally focused on inpatients. There are more studies and quality improvement measures emerging about surgical quality improvement in the latter half of the last decade. The next frontier will be affecting where the majority of patients receive their care—out of the hospital. Finally, my thoughts on the last macro level trend would be focused attention on “getting to zero.” I do not know whom to attribute this classic quotation to, but it has been garnering significant attention in the patient safety and quality improvement world. The basic concept is even one child harmed is one too many, etc. The concept of “getting to zero” is to completely eliminate medical error as a source of patient harm. Of course, this is a lofty goal and perhaps not even attainable, but it is nevertheless worth striving for. In the past decade, major institutions have noted a marked decrease in serious safety events by more than 80 percent. Just as in most business and operations, the next 20 percent will take most of the effort and time. It will be interesting to see the path that the patient safety and quality improvement initiatives take in the coming years, but I believe the next goals will focus on collaborative initiatives to drive improved outcomes, an increased focus on outpatients (where most patients receive care), and finally there will be significant efforts geared toward “getting to zero.” We encourage members to write us with any topic of interest and we will try to research and discuss the issue. Members’ names are published only after they have been contacted directly by Academy staff and have given consent to the use of their names. Please email the Academy at qualityimprovement@entnet.org to engage us in a patient safety and quality discussion that is pertinent to your practice.