Ironically, North Carolina was chosen for the study because of that state's recent emphasis on reducing medical errors. "It's a fair study. It points out that there is much more work to be done despite the fact that we have had some very intense efforts in this state over the last five years," says Don Dalton, vice president and spokesman for the North Carolina Hospital Association. "A little to our disappointment, the years of the study didn't coincide with some of our years of greatest improvement. We created a quality center here in 2005 so we have done a lot in the last five years and three of those five years would not have been included in the study."
Dalton says NCHA and its member hospitals have worked hard to reduce central line bloodstream infections and surgical site infection. "More importantly we have done a lot of work with hospitals around the issue of creating just cultures, where hospitals are taking greater responsibility for changes in the system that would eliminate the opportunity for harm, and healthcare professionals continuing to take personal responsibility for their actions. We feel like it is the system work that has the greatest opportunity to improve the quality of care," Dalton says.
In some respects, Foster says, the two studies' results also reflect the improving quality of data collection and identification of hospital errors. "What I see in these two studies is that we have learned an enormous amount about safety and our risks to patients, what might constitute an error and new ways to identify them which are much more robust than the original methodology used in the Harvard Medical Practice study which was the foundation of the IOMs original estimate," Foster says.
"In addition we now see more things as potentially preventable than we did a decade ago," Foster says. "The biggest example is central line bloodstream infection. We used to think of them as having a certain level of inevitability and now we know we can get very close to zero with them. That's terrific news for patients but it does mean the count of things that are preventable has gone up."