Friday, March 25, 2011

Latent Failure: No MESH heading for patient safety?

There was a comment/query recently on a medical librarians listserv bemoaning the lack of a MESH (National Library of Medicines "Medical Subject Heading) on the distinct topic of patient safety. My responsed to the dialogue are repurosed below:

There is the rub, Stanley!

Patient safety is a really complex issue to track and it would be helpful to have a term that encompasses all the nuance, but perhaps a MESH term wouldn't be appropriate but instead a taxon around the topic or a defined hedge (clinical query) that would address these nuances when applied by learned searchers.

These documents illustrate the range of types of things that need to be looked at to do comprehensive research around patient safety:

I wonder if some of the issues around this center on the fact that patient safety -- even for those of us who have been doing this for a long time
doesn't have concrete boundaries and so it would be hard to create a term that could encompass them all. Just ask a group of healthcare folks to define quality and then patient safety ...... that designation alone is stuff up for debate even a decade after "To Err is Human."

I think we need an entire set of terms --- there are several recognized taxonomies that take into account the range of ideas that need to be represented when tagging for "patient safety":

PSnet collection taxonomy

But I recognize this opens up a whole new can of worms ----


I have been tracking and watching the patient safety literature since 1997. Its very, very messy and anything that could be put in place to standardize the literature would be helpful. Then -- training would have to be done to make sure terms would be applied consistently -- as this lack of reliabilty represents a human factors and systems-level problem that is latent (in systems safety terms) in that people don't see the failure of finding things given how poorly applied the terms are.

Add to that the fact the "patient safety" is not even used consistently by the people who WRITE the articles --- let alone the marketing value of the term ....

This is such a good example of why you need PEOPLE to look at the literature and determine its usefulness and relevance. This point is important even - with clinical terms that are more tightly defined ....


I appreciate the interest and concern librarians and other experienced researchers/informaticians take in recognizing the problems associated with accessing the exploding literature around safety. Measures to understand this problem and an awareness of it as a failure to report and a near miss to recognize (when caught in the process of searching oneself or in reviewing a clinicians search) may help address the problem.


Lorri Zipperer said...

Thanks to my colleague Jeannine Gluck for the following comment:

Well, the day is coming soon for an end to this problem. The 2012
MeSH vocabulary includes PATIENT SAFETY, defined as "Efforts to reduce risk, to address and reduce incidents and accidents that may
negatively impact healthcare consumers." New MeSH files generally become functional in November or December.

I learned of this change serendipitously when perusing the MeSH files to see if there were any new cancer-related terms relevant to an upcoming class. If you want to view the file, go to the Sept. 2011 NLM
Technical Bulletin--see
You'll need to fill out a form, and download the files.

Thanks to everyone who may have lobbied NLM for this addition. Please realize that the MeSH homepage contains a link for suggestions for needed terms. As long as the requestor can demonstrate the volume of articles on the subject, and the problems with searching the concept otherwise, NLM staff is receptive.

Please feel free to forward to other lists.


Jeannine Gluck
Director of the ECHN Library
71 Haynes St.
Manchester, CT 06040

Lorri Zipperer said...

Others that might play out for us are: