Web Chat Transcript: Patient Safety Research
Web Chat Transcript
On April 11, 2001, Gregg Meyer, M.D., answered questions in a Web chat about the patient safety research program of the Agency for Healthcare Research and Quality (AHRQ). Dr. Meyer is Director of the Center for Quality Improvement and Patient Safety, AHRQ.
Only a partial transcript is available because of technical issues. It has been edited for clarity.
Question: Significant numbers of medications are given to children every day in schools, pre-schools, and daycare settings. Systems of medication delivery at such institutions are too often sub-optimal or do not exist at all. How does AHRQ plan on reaching out to school-based programs?
Dr. Meyer: This could be part of our effort to move beyond inpatient settings, and investing research here may be an important first step. We hope to obtain applications which will cover a wide range of settings, including inpatient care, outpatient care, home care, long term care.
Question: There is some confusion about what AHRQ considers to be patient safety. Is it freedom from accidental injury (definition of the Institute of Medicine [IOM]) or does it include nondelivery of preventive services or inadequate control of a chronic condition? Specifically, does failure to follow well-known protocols—which address risk factors related to patient safety issues such as weight loss—fit under your definition of "medical errors?"
Dr. Meyer: There is a question about the boundary between quality of care concerns and patient safety. We use the definitions included in our research solicitations as a mechanism to inform the field about how we define these issues. The definition we have asked grantees to use has been stated explicitly in each of the requests for applications (RFAs) and comes from "Doing What Counts," the report of the Quality Interagency Coordination (QuIC) Task Force. It is the responsibility of the applicant to make the case as to how the particular issue they want to focus on is indeed something to be considered under our working definition of patient safety.
Question: Would you comment on the faster pace of drug development and how this impacts patient safety?
Dr. Meyer: We are also working in partnership with the Food and Drug Administration (FDA). In particular, we are examining how we can use existing data collection activities at the FDA to promote patient safety research. The question posed here is one which clearly would require further research and was identified as an important issue during our research summit.
Question: Should we ban handwritten prescriptions?
Dr. Meyer: Research sponsored by the agency demonstrates that adverse drug events can be prevented by systems which take physician handwriting out of the process. This is one of the best examples of the systems approach. However, the decision over whether handwritten prescriptions should be banned as a policy is one which is clearly beyond the authority of this research agency. The case for eliminating handwritten prescriptions is compelling.
Question: Are there any databases from previous studies concerning rates (gross or specific) of errors and accidents?
Dr. Meyer: Assessing rates for patient safety events is problematic. There has been great debate over how to specify the denominator for tracking rates. Unlike the traditional epidemiologic approach taken in most health services research, patient safety may be one area where we can learn a great deal from numerators alone.
Question: How about failure to communicate test results?
Dr. Meyer: We recognize that breakdowns in the communication of results is an important problem in patient safety. This was recognized in our document, Five Steps to Safer Health Care, which is available on our Web site.
Question: Why did AHRQ dedicate so much of its patient safety budget to directed RFAs and relatively little to investigator-initiated (RO1) research for patient safety-related work?
Dr. Meyer: Our approach was dictated by critical inputs into our patient safety research agenda. These included not only the patient safety research summit mentioned earlier, but also specific requirements in our congressional appropriations language. Whenever possible, we would like to accomplish our research mission through investigator-initiated research, but in this case, those critical inputs dictated that much of our 2001 patient safety research be solicited through targeted mechanisms. Nevertheless, we are interested in investigator-initiated research related to patient safety and would encourage applications outside of our RFAs which would compete within the general pool of AHRQ grant applications.
Question: How do you address the concerns of hospitals that implementing a formal medication safety program may actually increase their risk of losing a lawsuit?
Dr. Meyer: This is an area where more research is needed. There are compelling anecdotes that this is indeed a problem. We need to have a stronger understanding of why this occurs and what are the solutions. The final RFA, on education and dissemination, is one mechanism we hope to use to improve communication practices.
Question: Other than the IOM definitions of error, have there been any other attempts to make more standard definitions for identification of errors and "near-misses," including more explicit (rather than implicit) criteria?
Dr. Meyer: We are working in partnership with the private-sector National Quality Forum and the Health Care Financing Administration (HCFA) to develop two types of patient safety measures. The first will be a parsimonious list of preventable events that should never occur. The second will be a compendium of evidence-based patient safety practices which is being produced by one of the agency's evidence-based practice centers. That compendium will be available late this summer. We think it is going to be an important resource for those dedicated to improving patient safety.