Hospitalization is a stressful experience even without the worry that a medical error could jeopardize recovery. A decade ago the Institute of Medicine released its report To Err is Human: Building a Safer Health System, which estimated that medical errors in hospitals led to the deaths of as many as 98,000 patients.  In response to the report, federal agencies developed several programs to reduce medical errors and they continue to enhance them as described below. 

In 2004, The Agency for Healthcare Research and Quality (AHRQ) released Hospital Survey on Patient Safety Culture, a tool designed for hospital staff to assess the culture of safety in their institution. This survey has been implemented by hundreds of hospitals in the United States and other countries. AHRQ followed up in 2006 by funding a database that allows comparison of the survey data submitted by hospitals. The comparative annual reports were available beginning in 2007 and will continue through at least 2012.

Now there’s a Resource List for Users of AHRQ’s Hospital Survey on Patient Safety Culture (The List). It provides links to websites that describe “practical resources” that can be used to improve hospital safety. For example, on the topic of “patient handoffs,” a known error-prone process, resources are described for physicians, for nurses, and for specific settings, such as the ER or perioperative units. In several cases, there are links to safety innovations described in AHRQ’s Health Care Innovations Exchange (highlighted in a previous blog post), such as M.D. Anderson Cancer Center’s “Good Catch” Program.

In addition to an alphabetical arrangement of resources, The List is organized in the following categories: Teamwork within Units, Supervisor/Manager Expectations and Actions, Management Support for Patient Safety, Organizational Learning, Overall Perceptions, Feedback and Communication, Communication Openness, Frequency of Events Reported, Teamwork across Units, Staffing, Handoffs and Transitions, and Nonpunitive Response to Error. The List is current as of January 2011 and will be regularly updated.

Although many safety reforms have been implemented since the IOM report, there’s still room to improve.

AHRQ is part of the U.S. Department of Health & Human Services.