Delivering safe health care

摘要

One fundamental guarantee that we cannot give our patients is that faults and errors in the healthcare system won't harm them. Of course, health care is by its nature risky. Not everyone undergoing surgery for an aortic aneurysm survives. Many interventions carry risks. But these risks are mostly small and usually quantifiable. Ideally, patients understand the possible risks and benefits before choosing to undergo a procedure. For some patients these are difficult decisions. Though doctors may discuss risks of treament, they do not speak about risks of harm from the system-or even about such harm when it occurs. Recent studies in the United States, Australia, and the United Kingdom and reports from the US Institute of Medicine and the UK Department of Health have drawn attention to the chronic "unsafeness" of health systems worldwide. This attention is not new. What is new is that preventable, iatrogenic injuries are being quantified and openly discussed. For example, adverse drug reactions have become a national issue in the United States-studies show that adverse drug events occurred in 6.5% of hospitalisations. By calling for solutions, these reports have highlighted the tensions between accountability and improvement, needs of individual patients and benefit to society, and production goals and safety.