By Dr. Anthony Policastro

In 1999 the Institute of Medicine published a report on the level of quality in U.S. hospitals. The title was To Err is Human. The basic message was that our systems needed improvement. There were too many loose ends.

Things looked at specifically included giving the wrong medication. This could be the wrong dose. It could be the wrong patient. It could be the wrong route. It could be the wrong time. Processes needed to be put into place to decrease the margin for human error.

They also looked at things like wrong site surgery. Today before every surgical procedure, the surgeon comes to initial the part of the body so the patient can make sure the initials are placed in the right location. There is a time out called to confirm that they have the correct patient. They confirm that the site is correct. They confirm that the procedure is correct. 

Hospital related infections have been addressed. These include hospital related pneumonia. They include hospital related blood infections. There have been many changes due to the report.

The Institute of Medicine has now prepared a new report. The title is Crossing the Quality Chasm. It has laid out another series of recommendations.

The first of those continues the underlying focus on patient safety. Systems need to be free from errors in the system itself.

The second focuses on resources. There need to be enough to get the job done right. However, there should not be so many that they get used unnecessarily just because they are there.

The third is patient-centeredness. Organizations have a tendency to focus on what makes them run well from a business standpoint. The focus should be on what makes them run well from a patient standpoint.

The fourth is timeliness. There are so many systems and processes in place in organizations that waits are common. 

When I used to admit patients from the ER, this used to drive me crazy. The patient was so sick that they needed to be in the hospital. That means that they need to be taken care of now. That means they need the antibiotic for their infection now. 

However, the process required the ER nurse to call the inpatient nurse and give report. It required both of them to not be busy. I used to go in and do my history and physical. If the report was not called in by then, I would personally escort the patient to the inpatient unit. This made everyone angry because I did not follow the process. The delay in the process was clearly not to my liking or to the patient’s needs.

The fifth item is efficiency. This focuses on reducing waste. The byproduct of this is reducing the cost of care.

The sixth item is equity. Care needs to be given based upon the patient’s illness. Medical insurance should not affect the care that they receive. Nor should their ability to pay for the care. That is not always the case.

The 1999 report really did transform a lot of the things we do on an everyday basis. Most of them were significant improvements. The Institute of Medicine is hoping that the next decade will see similar strides in improved medical care.

COVID update- Nationally, the number of new cases went from 295,000 last week to 237,000 this week. The numbers continue to slowly drop.

In Sussex County after being at about 190 new cases for the last two weeks, the numbers are up to 277 this week. 

However, the number of new patients admitted with COVID-19 infection and total number of COVID-19 patients in the hospital continue to decrease. That suggests that even though there are more cases, they tend to be mild enough to not require hospital care.