The Current Situation in Health Care The Quality Chasm

Much has been written lately about the inadequate quality and safety in health care. A very strong whistleblower on safety issues was the report, "To Err Is Human: Building a Safer Health System," published by Institute of Medicine (IOM) in 2000. According to an estimate in that report, 7% of all hospitalized patients experience a serious medication error, and 44,000 to 98,000 Americans die in hospitals each year from care injuries (6). Similar figures from all parts of the western world have been published—the United Kingdom, Denmark, Australia, and other countries. The types of errors that occur can be divided into diagnostic, treatment, preventive (failure to provide prophylactic services) and other processes, for example, failures in communication. In pediatrics, we have also learned that our field is particularly at risk for medication errors, owing to the complexity dosing and administering of drugs to children and the scarcity of studies on children and drugs. Studies show that errors occur in 5 of 1000 medication orders in pediatrics, and the most prevalent is overdosing (6) The follow-up IOM report (2001) states, on the basis of numerous examples of underuse, overuse, and misuse of medical services, that there is not only a gap, but a chasm between the evidence-based knowledge and the actual performance and outcomes in health care. This happens despite the fact that everyone in health care tries their best to get it right. The reality of the current situation is that the problems are caused by the increased complexity in health care and the fragmentation of care processes—and only by changing the system can sustainable change be made with significantly improved measured outcomes (7).

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