Doctors criticize patient safety recommendations for not including common-sense methods

Tuesday, July 23rd 2002, 12:00 am
By: News On 6

CHICAGO (AP) _ Some safety experts say a government-commissioned report on reducing medical errors neglects simple, common-sense ideas such as using checklists and counting surgical sponges to make sure none are left inside the patient.

The report, sent to doctors nationwide by the U.S. Agency for Healthcare Research and Quality, highlights only practices that have been rigorously studied, such as using ultrasound to help guide the insertion of intravenous tubes.

``For policy-makers to wait for incontrovertible proof of effectiveness before recommending a practice would be a prescription for inaction and an abdication of responsibility,'' safety experts said in a critique in Wednesday's Journal of the American Medical Association.

The critique was written by Drs. Lucian Leape and Donald Berwick of Harvard University's School of Public Health and Dr. David Bates of Harvard Medical School. Berwick is president of the Institute for Healthcare Improvement, a nonprofit group that offers instruction on patient safety.

The 600-plus-page report was commissioned by the health care agency in response to concerns about medical errors. In 1999, the Institute of Medicine said medical errors contribute to more than 1 million injuries and up to 98,000 deaths annually. It also recommended the agency distribute a list of best safety practices to all doctors. It was released last year.

The JAMA critique called the report a ``superb and groundbreaking compendium of what is known about the evidence of effectiveness'' of certain methods of preventing complications.

But the critique cited several simple methods customarily used by doctors to prevent mistakes _ including checklists, sponge counts and techniques to ensure surgeons operate on the right spot _ that were not in the report.

``It would be tragic if these omissions were interpreted as reasons to discontinue these practices,'' the critique said.

The experts said the report focuses too much on advances in medical science and gives short shrift to safety practices that could prevent drug errors, such as having a pharmacist on call in hospitals around the clock, educating patients about their medications, and using computerized records.

The authors of the government-commissioned report, led by Dr. Kaveh Shojania of the University of California at San Francisco, agreed that efforts to improve patient safety should include practical, low-risk methods that seem to work but have not been thoroughly studied. But they also argued that practices that seem common sense may also cause harm.

Dr. Gregg Meyer, the health care agency's director of quality improvement and patient safety, said the report should not be considered a complete list of methods to reduce medical errors.

``These aren't the Ten Commandments,'' Meyer said. He added: ``As a compendium of evidence, we think this is great, and we also think it will need updating.''