Peter Pronovost, MD, PhD, is a professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine. Although he works right in the heart of mainstream academic and clinical medicine, Dr. Pronovost is taking an unusual and even heroic step and speaking out about medical errors. Tens of thousands of people are dying unnecessarily, he says, and one main reason involves the enormous arrogance of many doctors.
In his commentary, published in the July 14 issue of the Journal of the American Medical Association (JAMA), Dr. Pronovost, who is a patient safety expert, argues no measurable, achievable and routine strategies to prevent patient harm even exist in the health care industry. In fact, he states there are too many barriers in the way to attain workable ways to protect patients — and at the top of the list is the arrogance of doctors “who are overconfident about the quality of care they provide or always believe things will go right and aren’t prepared when they don’t, and of hospital officials who fail to aggressively address problems like hospital-acquired infections.”
In his JAMA paper, Dr. Pronovost points out that each year about 100,000 people die from health care-associated infections, another 44,000 to 98,000 die of other preventable mistakes and tens of thousands more die from diagnostic errors or failure to receive recommended therapies. Unfortunately, there is limited evidence these patient outcomes are improving, either. “It’s unconscionable that so many people are dying because of these arrogance barriers,” Dr. Pronovost said in a statement to the media. “You can’t have arrogance in a model for accountability.”
There is one area where patient safety is improving — in the area of central line-associated bloodstream infections — at least, in a few hospitals. Although these deadly infections remain common, enormously expensive and kill over 30,000 Americans a year, they are now known to be largely preventable due to Dr. Pronovost’s own research and innovations. He introduced a simple checklist into hospital intensive care units (ICUs) at Johns Hopkins and then the entire state of Michigan. Wherever the checklist was consistently used, these life-threatening infections were reduced to almost zero.
However, here’s the most surprising part of this story. Dr. Pronovost admits it wasn’t only his checklist that led to the dramatic improvements in patient safety in these ICUs. The infection rate was reduced in ICUs where nurses were finally allowed and even encouraged to question doctors who had previously been treated as god-like experts who were not to be challenged.
When nurses spoke out about physicians who might have skipped a step or otherwise violated safety protocols, infection rates plummeted. Dr. Pronovost says the bottom line is this: patient safety must be put ahead of individual egos.
So are all hospitals and physicians getting on board to follow the checklist and to change hospital culture so they can prevent ICU infections and save tens of thousands of lives? The answer is a resounding and disappointing “no”. Dr. Pronovost reports US hospitals have been extremely slow in enrolling in the program. In some states, less than 20 percent of hospitals have volunteered to participate.
“Some hospitals have reduced infections, most have not. Some hospitals claim they use the checklist, despite having high or unknown infection rates. Some hospitals are content to meet the national average, despite evidence that these rates may be reduced by half. Some hospital administrators say their patients are too sick; these infections are inevitable. Yet, intensive care units in several large academic hospitals have nearly eliminated CLASBIs, or central-line associated bloodstream infections. Some hospitals blame competing priorities for their inattention to these infections,” Dr. Provonost writes. “If these lethal, expensive, measurable, and largely preventable infections are not a priority, what is?”