Temporal trends in rates of patient harm resulting from medical care.
Landrigan CP, Parry GJ, Bones CB, Hackbarth AD, Goldmann DA, Sharek PJ. N Engl J Med. 2010;363:2124-2134.
Landrigan CP, Parry GJ, Bones CB, Hackbarth AD, Goldmann DA, Sharek PJ. N Engl J Med. 2010;363:2124-2134.
Interesting study with not-so-surprising results: patient safety isn't improving as quickly as hoped -- even in hospitals that are highly engaged in improvement. Systemic solutions need to be in place to help ensure improvements - rather than only the launch of tools (ie checklists)
This patient safety improvement stuff is tough work, yet its frustrating to hear this.
I see the conclusion: “Further efforts are needed to translate effective safety interventions into routine practice and to monitor health care safety over time” as areas where librarians, informationistas, informaticians, etc can make an impact. There are knowledge access, knowledge sharing, evidence assess and sharing, data access and packaging issues that we in the info professions may be able to affect and improve, if the multidisciplinary teams driving improvement initiatives includes information and knowledge sharing experts (not just IT). It also means (in our sphere of influence) that wikis, SharepointTM, EBM etc are not the be all end all of our contributions -- we need to help others see how culture and work process is affected and made more reliable through effective information and knowledge sharing.
The effort continues ....
This patient safety improvement stuff is tough work, yet its frustrating to hear this.
I see the conclusion: “Further efforts are needed to translate effective safety interventions into routine practice and to monitor health care safety over time” as areas where librarians, informationistas, informaticians, etc can make an impact. There are knowledge access, knowledge sharing, evidence assess and sharing, data access and packaging issues that we in the info professions may be able to affect and improve, if the multidisciplinary teams driving improvement initiatives includes information and knowledge sharing experts (not just IT). It also means (in our sphere of influence) that wikis, SharepointTM, EBM etc are not the be all end all of our contributions -- we need to help others see how culture and work process is affected and made more reliable through effective information and knowledge sharing.
The effort continues ....
4 comments:
Love the term: Informationistas! This is my reaction to your FB post, btw.
Hi Lorri,
I think part of the problem is in the process management portion of the knowledge transfer. Patient safety makes perfect sense, but slow roll out of the implementation of new practices and procedures designed to capture the "lessons learned" makes all the difference. That's what I notice in the legal field anyway. I'd be interested to hear the specifics of implementation in the health field sometime. You probably are already doing this anyway.
Hey Lorri, this is an interesting article, I'll be passing it along to some others.
Lorri,
This is frightening. There is also an interesting article in the WSJ today about a surgeon performing an unusually high number of heart stent procedures with the implication that many were not necessary. It is difficult for patients to trust that their safety is paramount when you read studies like this.
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