AHRQ Welcomes Your Comments on Draft Report to Congress about Improving Patient Safety

The Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act) was seminal legislation aimed at accelerating the Nation’s efforts to improve patient safety. Among other provisions, it allowed for the establishment of patient safety organizations (PSOs), which work with healthcare providers across organizational and State boundaries to improve the safety and quality of healthcare.

Fifteen years later, efforts to increase patient safety continue. Although we still see too many events such as adverse drug reactions, infections, or falls, momentum for improvement is clearly growing. Recent years have seen a steady reduction in hospital-acquired conditions, for example. AHRQ is also helping to lead a national effort to improve diagnostic safety.

The growth of PSOs is another reason for optimism. At this writing, there are 94 PSOs listed by AHRQ, and their work with healthcare providers is highly valued, successful, and thriving. The Patient Safety Act provides Federal legal privilege and confidentiality protections for information exchanged between healthcare providers and PSOs for the purpose of learning about how to improve patient safety. Patients’ rights to their medical information is not compromised.

The Patient Safety Act also created the network of patient safety databases (NPSD), a valuable national resource for improving patient safety. The NPSD, launched in 2019, is growing into an ever-more-robust national resource for patient safety and quality improvement.

Another milestone in the landmark Patient Safety Act has now been reached with the release of “Strategies to Improve Patient Safety: Draft Report to Congress for Public Comment and Review by the National Academy of Medicine” for public comment. In addition to an overview of the Patient Safety Act and its implementation, the draft report reviews some principles and concepts underlying effective patient safety improvement, provides an overview of research and measurement in patient safety, and presents the strategies and practices for reducing medical errors and increasing patient safety reviewed in AHRQ’s Making Healthcare Safer reports, published in 2001, 2013, and 2020.

The draft report also describes an approach that has shown success in encouraging providers to use effective practices to improve patient safety, and outlines measures that could accelerate progress in improving patient safety and encouraging the use of effective patient safety improvement strategies. Through this report and related resources such as the National Action Plan to Advance Patient Safety, AHRQ is working with organizations who recognize the need to prioritize patient safety, and together we are navigating the journey to safer care.

As the Nation’s lead Federal patient safety agency, AHRQ remains committed to working with patients, healthcare professionals, researchers, and other stakeholders to make a difference in patient safety. That’s why we encourage you to review the draft report and send comments to PSQIA.RC@ahrq.hhs.gov no later than Feb. 16. We’ll review feedback in developing a final report for Congress later this year.

Jeff Brady is Director of AHRQ’s Center for Quality Improvement and Patient Safety. Andrea Timashenka is Director of AHRQ’s PSO Program.

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