INTERNAL BLEEDING

Despite its alarmist subtitle, a thoughtful analysis of why medical errors happen, with concrete proposals for improving the safety of patients.

Wachter and Shojania (both Medicine/Univ. of California, San Francisco) are deeply involved in patient safety and hospital quality issues. Using dramatic cases from their own experience and from health-care publications and websites, they demonstrate the various ways in which things can and do go wrong. The authors look behind the headlines to examine why medical errors such as wrong-site surgery, procedures performed on the wrong patient, missed diagnoses, and wrong prescriptions happen in operating rooms, emergency rooms, and pharmacies, even in the hands of competent, well-intentioned caregivers. Taking a systemic approach, they look at how root-cause analysis, which has been used by airlines and other industries, can be applied to the problem of patient safety. With increased specialization has come greater fragmentation of patient care, state the authors, who spell out the need for clearer communication among caregivers and stricter protocols for handing off patients. They note, for example, that the computerized systems now used in some hospitals to enter physician orders greatly reduce medication errors at the prescribing and order-filling stage. They also look at the culture of safety within institutions, the importance given to safety issues, how doctors talk to each other about mistakes, how the traditional morbidity and mortality conferences and error-reporting systems function and might be improved, and what might be done to reform the present malpractice system. In their concluding chapters, the authors consider what actions the government, policymakers, and hospital administrators should take to improve patient safety. Most significantly for the reader, they outline steps that patients can take to protect themselves.

Delineates a serious problem and sounds a clear call to action.