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:

http://psnet.ahrq.gov/resource.aspx?resourceID=2123

http://psnet.ahrq.gov/resource.aspx?resourceID=1599

http://psnet.ahrq.gov/resource.aspx?resourceID=19096

http://www.ncbi.nlm.nih.gov/pubmed/20457733

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
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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":

http://www.ncbi.nlm.nih.gov/pubmed/15723817

http://www.who.int/patientsafety/taxonomy/en/

PSnet collection taxonomy

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

AND

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 ....

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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.