The Agency for Healthcare Research and Quality (AHRQ) has announced $50 million in new research grants, contracts, and other activities to reduce medical errors and improve patient safety. This initiative represents the single largest investment the Federal Government has made so far to combat the estimated 44,000-98,000 patient deaths related to medical errors each year.
These fiscal year 2001 projects are part of a multiyear effort that will address key unanswered questions about how errors occur and provide science-based information on what patients, clinicians, hospital leaders, policymakers, and others can do to address this critical problem. The results of the research will include information on errors and patient safety improvement strategies that work in hospitals, doctors' offices, nursing homes, and other health care settings in urban and rural areas across the Nation.
Congress directed AHRQ to begin these activities as part of the Federal Government's response to the 1999 Institute of Medicine report, To Err Is Human: Building a Safer Health System. To help set priorities for these efforts, AHRQ and its Federal partners asked for input from consumers, providers, and policymakers at a national research summit last year. Many questions were raised at the summit that this research will help to answer. These include:
- What errors occur in settings other than the hospital, and how can these settings be made safer?
- What is the best way to report errors in order to learn from them?
- What effect can organizational factors like hospital leadership, culture, and working conditions have on reducing potential harm to patients?
The 94 patient safety projects funded by AHRQ will be carried out at State agencies, major universities, hospitals, outpatient clinics, nursing homes, physicians' offices, professional societies, and other organizations across the country. These projects fall into the following six categories:
Collecting and Reporting Data on Medical Errors.
This major new investment involves $24.7 million for 24 demonstration projects that will examine different methods of collecting and analyzing data on errors to identify factors that put patients at risk of medical errors.
For example, a $1.7 million project at the Department of Health in New York and a $1.3 million project at the Department of Public Health in Massachusetts will examine how to improve the effectiveness of State-mandated reporting of errors. A $2.8 million project at Harvard Pilgrim Healthcare will evaluate data collected from more than 16,000 primary care physicians participating in 10 of the Nation's leading health maintenance organizations (HMOs) to identify medication errors and test ways to prevent them.
In addition, a $2.3 million project at Johns Hopkins University in Baltimore, where researchers are working with the Society of Critical Care Medicine, and a $1.6 million project at the American College of Surgeons in Chicago will study how professional societies can identify and get their members to respond to risks in the care they provide. A $1.4 million project at Harvard University in Boston will examine the use of data from malpractice cases as a source of information about risks and the effectiveness of using that information to reduce the chance that a patient will be harmed.
Using Computers and Information Technology to Prevent Medical Errors.
These activities include 22 projects for $5.3 million. The researchers will develop and test the use of computers and information technology to reduce medical errors, improve patient safety, and improve quality of care.
For example, a $255,000 project at the University of Alabama at Birmingham and another $345,000 project at Creighton University in Omaha will test whether the use of hand-held computers with decision support systems can reduce medical errors in primary care clinics. A $496,000 project at Montefiore Medical Center in New York City will use computer simulation tools to train surgery residents and to identify, quantify, and analyze errors and "near misses." A $275,000 project at the University of Chicago will identify factors that lead to errors in the use of infusion pumps to give patients intravenous fluids and medicine.
Working Conditions and Patient Safety.
Eight projects ($3 million) are included in this category. Researchers will examine the critical issues of how staffing, fatigue, stress, sleep deprivation, organizational culture, shift work, and other factors can lead to errors. These issues—which have been studied extensively in aviation, manufacturing, and other industries—have not been closely studied in health care settings.
For example, a $394,000 project at the University of California, San Francisco, will assess the relationship between daily changes in the working conditions in hospitals—including nurse staffing ratios, workload, and skill mix—and medical errors.
Innovative Approaches to Improving Patient Safety.
This category includes 23 projects ($8 million). Researchers at health care facilities and organizations in geographically diverse locations will develop innovative approaches to improving patient safety.
Researchers will study how to improve teamwork among health professionals to reduce harm to patients. For example, a $1.4 million project will create a Center of Excellence in Patient Safety Research at the University of Texas in Houston that will apply lessons from crew resource management in aviation to create stronger teamwork in health care. Another $168,000 project at the University of Chicago will examine how to improve communication and other aspects of teamwork.
Disseminating Research Results.
These seven projects ($2.4 million) will educate clinicians and others about the results of patient safety research. This work will help develop, demonstrate, and evaluate new approaches to improving provider education in order to reduce errors, such as applying new knowledge on patient safety to curricula development, continuing education, simulation models, and other provider training strategies.
For example, several large health care provider organizations—including the American Hospital Association's Hospital Research and Educational Trust, the American College of Physicians-American Society of Internal Medicine, the American College of Surgeons, and the National Patient Safety Foundation—will receive funding totaling more than $1 million to test the effectiveness of educational strategies. Another project will study ways of sharing information modeled on hospital and medical school "morbidity and mortality" conferences.
Other Patient Safety Research Initiatives.
To round out the $50 million patient safety portfolio, AHRQ also has provided $6.4 million in funding for 10 other projects. These include activities to expand the evidence base on what works and doesn't work in improving safety; support for meetings of State and local officials to advance local patient safety initiatives; funding for small businesses to explore new products to help improve safety; the use of existing integrated systems of hospitals, doctors' offices, and other facilities to study issues related to safety and quality of care; and a study to assess the feasibility of implementing a patient safety improvement corps.
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