Better teamwork key to maintaining patient safety

Organizations discuss how backup systems and other steps can mitigate the ill effects of errors.

By Andis Robeznieks — Posted Feb. 7, 2005

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Recognizing that the increasing complexity of medicine brings with it a host of new hazards for patients, representatives from 27 health care organizations met in Washington, D.C., to come up with a plan to do something about it.

In a statement developed at the Patient Safety and Medical System Errors in Diabetes and Endocrinology Consensus Conference, participants called for improving teamwork, making better use of information technology and expanding professional and patient education to help patients live longer and better lives.

"We needed to come together and examine the evidence and come up with recommendations for solutions to the problems we see," said Richard Hellman, MD, conference chair and University of Missouri/Kansas City School of Medicine clinical professor of medicine. "I think the people who have the most power to do something about these problems are the doctors -- because we have the most responsibility. But we have to do it with help from a lot of others."

Hosted by the American College of Endocrinology and the American Assn. Of Clinical Endocrinologists, the conference was held Jan. 9-10 and featured presentations by World Medical Assn. President Yank Coble, MD, past president of the AMA; Josie Williams, MD, PhD, from the AMA-led Physician Consortium for Performance Improvement; and AMA House of Delegates Speaker Nancy H. Nielsen, MD, PhD.

"It was very exciting," said Dr. Nielsen, an internist from Buffalo, N.Y., and a former member of the National Patient Safety Foundation board of directors. "The profession came together as a whole at the conference to identify the key maneuvers we should be doing."

While having a general emphasis on patient safety and systemic medical errors, the conference focused on diabetes, osteoporosis, pediatric endocrinology, thyroid management, bariatric surgery and cancer as specific areas of concern.

Dr. Hellman, who also serves on the AACE board and is a member of the Physicians Consortium, said the conference looked at how systems have to take into account the fact that everyone makes mistakes.

"Every human being makes errors," he said. "What we're interested in is not ending errors; it's ending injury to patients. It's a whole different ballgame, and it involves a system."

The importance of the conference's call for better teamwork was highlighted in a report Dr. Hellman published in Endocrine Practice last year. Dr. Hellman wrote how 33% of medical errors that cause death within 48 hours involved insulin and administration in the care of a patient.

Even if the medical staff is especially careful, the report described how a lack of coordination between health care professionals who administer medications and support staff who deliver patients food could cause problems.

"Doctors can write the order properly, nurses can give it properly, but if the food tray doesn't come in time, the patient gets hypoglycemic," he said. "It is a situation that requires more vigilance and cooperation from people used to working independently."

Dr. Hellman explained how the consensus statement's call for backup checks includes a system that involves physicians, nurses, computers, pharmacists and even patient family members to make sure the sickest patients receive the care they need.

Although patient safety often has a hospital-based focus, Drs. Hellman and Nielsen noted that primary care physicians have an important role to play in improving patient safety.

Dr. Hellman said an important aspect was the coordination of care between primary care physicians and specialists, and Dr. Nielsen noted that more patient safety research needed to be done -- with avoiding medication errors being a special area to focus on.

"Because the spotlight has been shone on hospitals, nobody really has a clue to what is in the outpatient arena -- but everyone thinks it's worse," she said. "We all need to make this complex health care system better."

In addition to looking at what physicians can do, Dr. Hellman said, others need to get involved: Lawmakers have to protect doctors who report errors from legal discovery, and third-party payers have to increase reimbursements to help cover the cost of information technology and allow physicians to spend more time with patients.

"Too many doctors are forced to do things that aren't safe -- like see 10 or 12 patients an hour when they really want to see only four or five," he said. "The best doctor in the world has to narrow their focus to get through that system. When errors occur, it's not that the doctor is bad; it's the pressure from the payer."

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Improving outcomes

Physicians at the Patient Safety and Medical System Errors in Diabetes and Endocrinology Consensus Conference created this strategy to help patients live longer and better:

  • Create a "culture of safety" that includes critical backup checks and blame-free discussion of errors.
  • Implement electronic records financed in part by increased third-party reimbursements.
  • Reduce errors with computerized physician order entry that checks for drug allergies, interactions and lab issues.
  • Improve coordination of care with a focus on teamwork, communication and education.
  • Improve patient self-care and treatment maintenance with education and communication and allow patients to access their own records.

Source: Conference consensus statement, Nancy Nielsen, MD, PhD, Richard Hellman, MD

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External links

Patient Safety and Medical System Errors in Diabetes and Endocrinology Consensus Conference position statement, in pdf (link)

"A Systems Approach to Reducing Errors in Insulin Therapy in the Inpatient Setting" abstract, Endocrine Practice, March/April 2004 supplement (link);

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