Last month marked the 10^th anniversary of the publication of the November 1999 publication of the Institute of Medicine's report, To Err is Human: Building a Safer Health System.  This landmark report highlighted the critical situation and the contributing factors in what it called the "nation's epidemic of medical errors."  Two oft-quoted statistics from the 1999 report were the estimated annual cost of these medical errors, between $17B and $29B annually, and the number who die in hospitals as a result of them, "at least 44,000 people, and perhaps as many as 98,000," each year.  In the intervening ten years since the IOM report we have clearly seen some improvements to patient safety, but there is still much need for improvement.

The 1999 IOM report discussed a wide spectrum of error types but tied the causes of most of them back to the U.S. healthcare system's problematic processes and procedures, which either result in medical errors or fail to prevent them.  The IOM-proposed solution centered on creating a focus on error prevention in our nation's hospitals, supported by error prevention technology such as computerized physician order entry (CPOE) and medication administration systems.  Responses to the report came from government, hospitals, payers and the private sector, and contained widespread acknowledgement of the critical situation outlined by the IOM yet little in the form of concrete plans or financial assistance for hospitals at the forefront. 

As we mark 10 years since this important publication, there is much discussion of the impact of the report and the progress made.  This past week, Robert Wachter published a paper in the journal Health Affairs, titled Patient Safety at Ten:  Unmistakable Progress, Troubling Gaps, which reflected on the progress on patient safety since 1999.  In his paper, Wachter, a professor of Medicine at the University of California, San Francisco, identifies 10 patient safety domains and assigns a letter grade to the industry's progress in each of the 10 domains.  In a midterm report in 2004 Wachter evaluated 5 of the domains, and the additional 5 are newly described in this paper.

The domains Wachter identifies where grades have slipped since 2004 include:

• Regulatory/accreditation, where early advances were made but advances since 2004 have been incremental
• Health IT, where slow adoption and growing evidence of IT-related safety hazards and implementation issues are emerging, although he notes the area will likely be helped by stimulus funding
• Workforce and training issues, as staffing shortages continue to contribute to poor engagement by providers

 Domains that identified strengths or showed improvement included:

• Reporting systems, where the advent of the National Quality Forum and "never event" reporting have driven gains
• Malpractice systems and accountability, where the grade is still poor but improved as a result of some improvements in leadership accountability
• Provider organization leadership engagement, a new category where strong performance resulted from a focus on safety at the senior level within provider organizations
• National and international organizational interventions, a new category where strength came from efforts by national and international organizations including the AHRQ, NQF, JCAHO, ACGME, WHO and IHI

 According to Wachter, the overall grade has improved slightly from a C+ in 2004 to a B- in 2009, resulting from improvements in safety reporting and leadership, and reflecting the promise of stimulus funding to address gaps in IT and accountability.  It is clear that the past 10 years have been important to patient safety, but stimulus funding over the next five years holds the promise of making an even-greater impact.