title: The long road to patient safety: a status report on patient safety systems.
abstract: BACKGROUND
  Since the Institute of Medicine (IOM) reports on medical errors and quality, national attention has focused on improving patient safety through changes in "systems" of care. These reports resulted in a new paradigm that, rather than centering on individual errors, focuses on the "systems" necessary to facilitate and enhance quality and protect patients.
  
  
  OBJECTIVE
  To assess the status of hospital patient safety systems since the release of the IOM reports and to identify changes over time in 2 states that collaborated on a patient safety project funded by the Agency for Healthcare Research and Quality.
  
  
  METHODS
  Survey of all acute care hospitals in Missouri and Utah at 2 points in time, in 2002 and 2004, using a 91-item comprehensive questionnaire (n = 126 for survey 1 and n = 128 for survey 2). To assess changes over time, we also studied the cohort of 107 hospitals that responded to both surveys.
  
  
  METHODS
  Responses to the 91-question survey as well as changes in responses to the survey questions over an 18-month period. Seven latent variables were constructed to represent the most important patient safety constructs studied: computerized physician order entry systems, computerized test results, and assessments of adverse events; specific patient safety policies; use of data in patient safety programs; drug storage, administration, and safety procedures; manner of handling adverse event/error reporting; prevention policies; and root cause analysis. For each hospital, the 7 latent variables were summed to give an overall measure of the patient safety status of the hospital.
  
  
  RESULTS
  Development and implementation of patient safety systems is at best modest. Self-reported regression in patient safety systems was also found. While 74% of hospitals reported full implementation of a written patient safety plan, nearly 9% reported no plan. The area of surgery appears to have the greatest level of patient safety systems. Other areas, such as medications, with a long history of efforts in patient safety and error prevention, showed improvements, but the percentage of hospitals with various safety systems was already high at baseline for many systems. Some findings are surprising, given the overall trends; for example, while a substantial percentage of hospitals have medication safety systems, only 34.1% [corrected] reported full implementation at survey 2 of computerized physician order entry systems for medications, despite the growth of computer technology in general and in hospital billing systems in particular.
  
  
  CONCLUSIONS
  The current status of hospital patient safety systems is not close to meeting IOM recommendations. Data are consistent with recent reports that patient safety system progress is slow and is a cause for great concern. Efforts for improvement must be accelerated.
authors.affiliation: Department of Family and Community Medicine, School of Medicine, University of Missouri-Columbia, MO 65212, USA. longod@health.missouri.edu
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Longo
authors.forename: John E
authors.initials: JE
authors.lastname: Hewett
authors.forename: Bin
authors.initials: B
authors.lastname: Ge
authors.forename: Shari
authors.initials: S
authors.lastname: Schubert
mesh_terms: D006739:Hospital Administration / Q000592:standards* / Q000706:statistics & numerical data; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D008923:Missouri; D011785:Quality Assurance, Health Care / Q000379:methods / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D017751:Safety Management / Q000379:methods / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013597:Systems Analysis; D014589:Utah