institute of medicine report on patient safety

A recent report on patient safety from the Institute of Medicine (IOM) of the National Academies, Crossing the Quality Chasm: A New Health System for the 21st Century, criticizes the US health care delivery system, finding it to be poorly designed and inept at meeting the needs of patients.

Full Answer

Is the Institute of Medicine doing enough to improve patient safety?

While the Institute of Medicine made recommendations to Congress for investigating medical errors and improving patient safety, the reality was that extensive foundation building needed to occur before meaningful improvements could be put into action.

How many patient safety articles are published after the IOM report?

The rate of patient safety publications increased from 59 to 164 articles per 100 000 MEDLINE publications (p<0.001) following the release of the IOM report. Increased rates of publication were observed for all types of patient safety articles.

What is the National Summit on medical errors and patient safety?

Later in 2000, under AHRQ leadership, that task force held a National Summit on Medical Errors and Patient Safety. The meeting focused on multistakeholder collaboration and input to be used by AHRQ in setting its patient safety research agenda.

Does the “To Err is human” report improve patient safety?

Publication of the report “To Err is Human” was associated with an increased number of patient safety publications and research awards. The report appears to have stimulated research and discussion about patient safety issues, but whether this will translate into safer patient care remains unknown.

What overall message was stated by the Institute of Medicine report To Err is Human?

The message in To Err is Human was that preventing death and injury from medical errors requires dramatic, systemwide changes.

What is a NAM report?

These reports represent the consensus recommendations from experts in the field regarding activities and future directions for health care quality and safety.

What is the 2000 IOM report?

Tracking The Changing Safety Net The 2000 IOM report found that the federal government lacked any comprehensive, coordinated ability to track and monitor the changing status of America's health care safety net and its success in meeting the needs of our most vulnerable populations.

What is a patient safety report?

Patient Safety Reporting (PSR) gives military treatment facility personnel the ability to anonymously report medical events that impact the safety of patients.

Is the National Academy of Medicine reputable?

An independent, evidence-based scientific advisor. Our foundational goal is to be the most reliable source for credible scientific and policy advice on matters concerning human health.

What is IOM now called?

April 28, 2015 -- The National Academy of Sciences has voted to change the name of the Institute of Medicine to the National Academy of Medicine effective July 1 as part of broader internal reorganization.

What did the IOM errors report show?

The Institute of Medicine (IOM) released a report in 1999 entitled “To Err is Human: Building a Safer Health System”. The report stated that errors cause between 44 000 and 98 000 deaths every year in American hospitals, and over one million injuries.

What was the focus of the 1999 Institute of Medicine report To Err Is Human?

To Err Is Human: Building a Safer Health System is a landmark report issued in November 1999 by the U.S. Institute of Medicine that may have resulted in increased awareness of U.S. medical errors.

Which quality issues were found in the Institute of Medicine IOM study To Err is Human: Building a Safer Health System?

Which quality issues were found in the Institute of Medicine (IOM) study, To Err is Human: Building a Safer Health System? Many errors are preventable. Data from the IOM study concluded that up to 98,000 patients die each year from preventable medical errors.

How do you write a patient report?

III. Patient case presentationDescribe the case in a narrative form.Provide patient demographics (age, sex, height, weight, race, occupation).Avoid patient identifiers (date of birth, initials).Describe the patient's complaint.List the patient's present illness.List the patient's medical history.More items...•

Why is patient safety reporting important?

It helps identify root causes: All healthcare incidents have a cause. The root causes must be identified—and corrected—to try to prevent adverse events from recurring. A patient incident report is a detailed, written account of the chain of events leading up to an adverse event.

What are the key elements of patient safety?

The key elements of a culture of safety include (1) a shared belief that although health care is a high-risk undertaking, delivery processes can be designed to prevent failures and harm to participants; (2) an organizational commitment to detecting and analyzing patient injuries and near misses; and (3) an environment ...

What is the new standard for care?

Patient Safety: Achieving a New Standard for Care. Americans should be able to count on receiving health care that is safe. To achieve this, a new health care delivery system is needed — a system that both prevents errors from occurring, and learns from them when they do occur. The development of such a system requires a commitment by all ...

Should Americans be able to count on receiving health care that is safe?

Americans should be able to count on receiving health care that is safe. To achieve this, a new health care delivery system is needed — a system that both prevents errors from occurring, and learns from them when they do occur. The development of such a system requires a commitment by all stakeholde ….

What is IHI's goal?

​​​​​​​​​​​Our goal: To advance a total systems approach to safety around the world. Together with like-minded health care leaders, organizations, practitioners, and patients, IHI drives innovative thinking and bold leaps forward that none of us could achieve on our own. More >>

Who is the CEO of IHI?

At the IHI Forum in early December, IHI CEO Kedar Mate made a case for patient safety solutions that help marginalized populations and also benefit the greater public.

What is the Patient Safety and Quality Handbook?

Given the central role that nurses serve in patient care and the likelihood that they are among the first health care professionals to recognize errors and prevent harm to patients, the Agency teamed with the Robert Wood Johnson Foundation to develop and distribute a handbook for nurses entitled Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Even though working conditions may be less than optimal and the needs of patients are quite diverse, the opportunities for patient safety and quality improvement are clearly addressed. More than 22,000 copies of the three-volume handbook have been distributed to nursing schools and clinicians in the field.

When was the IOM report released?

Setting a Direction. In early 2000, just 60 days after the IOM report was published, the Federal Government, through an AHRQ-led task force, released Doing What Counts for Patient Safety: Federal Actions to Reduce Medical Errors and Their Impact.

What is AHRQ Advances in Patient Safety?

AHRQ released Advances in Patient Safety: From Research to Implementation as a way to share the progress occurring in the first half of the decade. The four-volume publication, comprising 140 articles, sought to bridge the gap between the research underway and its integration into practice. The compendium covered a wide range of research paradigms, clinical settings, patient populations, reporting systems, measurement and taxonomy issues, tools and technology, implementation challenges, safety culture, and organizational considerations. The volumes helped fuel efforts to improve patient safety and provided a measure of progress. More importantly, they also provided a sense of remaining challenges.

What is AHRQ WebM&M?

AHRQ WebM&M serves as a free, online journal and forum for the examination of a variety of patient safety and quality issues. It features analysis of medical error cases by recognized experts and provides interactive learning modules for health care professionals, clinicians, administrators, patient safety officers, and trainees. Since its launch, AHRQ WebM&M has grown in popularity and continues to be one of AHRQ's most frequently visited Web sites.

What is a PSIC?

In response to the need to expand the patient safety knowledge and skills of midlevel professionals responsible for investigating medical errors and initiating improvements, AHRQ partnered with the Department of Veterans Affairs' National Center for Patient Safety and began the first of four 9-mont h Patient Safety Improvement Corps (PSIC) training programs. Participants received training on tools and topics including analyzing root causes, analyzing health care failure modes and effects, applying human factors principles, assessing patient safety culture, and making a business case for patient safety. By the program's end, teams had been trained in every State, as well as the District of Columbia and Puerto Rico. Feedback the Agency received that PSIC graduates were, in turn, training their own personnel in patient safety principles acquired from the program provided evidence that this program represented a significant step in disseminating patient safety knowledge throughout the country.

What is the most common complication of hospital care?

Data indicate that health care-associated infections (HAIs) are the most common serious complication of hospital care, striking nearly 2 million U.S. hospital patients, resulting in an estimated 99,000 deaths, and costing the health care system up to $20 billion each year, according to the Centers for Disease Control and Prevention (CDC). The most common HAI is methicillin-resistant Staphylococcus aureus (MRSA). With some MRSA-related projects already underway, Congress directed AHRQ to work with its Federal partners at the CDC and the Centers for Medicare & Medicaid Services to develop an action plan to identify and help reduce the spread of MRSA and related HAIs. The action plan is designed to:

How does the Health Information Technology Agency help?

To provide technical assistance and share knowledge and findings , the Agency established a National Resource Center for Health IT. All of the lessons learned from these projects are helping health care providers move closer to a fully operational health IT system in support of improved quality, safety, and continuity of care.