A much needed commentary on patient safety recently appeared in the pediatric literature. Schroeder, Harris, and Newman (Schroeder 2011), in commenting on the American Academy of Pediatrics recent policy statement Principles of Pediatric Patient Safety: Reducing Harm Due to Medical Care, note that missing in almost all the literature on patient safety is a statement about avoiding many of those interventions that eventually cause harm.
When we do a root cause analysis (RCA) after an untoward incident or near-miss one of the first questions we usually ask is “Was the procedure/surgery/medication indicated?”. You’d be surprised how many organizations fail to consider that during their RCA’s.
There are plenty of examples of improving patient safety by doing less. We know that the most important step in reducing healthcare-associated infections like CAUTI’s and CLABSI’s is avoiding unnecessary use of the catheters in the first place. And we see over and over again complications of procedures that were done for ambiguous indications. A recent article in the Archives of Internal Medicine “Less is More” series (Sirovich 2011) found that many US primary care physicians believe that their own patients are receiving too much medical care. They cite the need for malpractice reform, realignment of financial incentives, and more time with patients to remove pressure on physicians to do more than they feel is needed. And another recent article in that series (Bellizzi 2011) showed that a high percentage of older adults continue to be screened for colorectal, breast, cervical, and prostate cancers in the face of ambiguity of recommendations for this group. Complications may occur from those screening directly or related to the actions the results lead to.
So we agree wholeheartedly: safely do less!
Schroeder AR, Harris SJ, Newman TB. Safely Doing Less: A Missing Component of the Patient Safety Dialogue (Commentary). Pediatrics 2011; 128:e1596-e1597
Steering Committee on Quality Improvement and Management and Committee on Hospital Care. Principles of Pediatric Patient Safety: Reducing Harm Due to Medical Care. Pediatrics 2011; 127: 1199-1210
Sirovich BE, Woloshin S, Schwartz LM. LESS IS MORE. Too Little? Too Much? Primary Care Physicians' Views on US Health Care. A Brief Report. Arch Intern Med. 2011; 171(17): 1582-1585
Bellizzi KM, Breslau ES, Burness A, Waldron W. LESS IS MORE. Prevalence of Cancer Screening in Older, Racially Diverse Adults. Still Screening After All These Years. Arch Intern Med. 2011; 171(22): 2031-2037