Navigating the Health Care System

Most people know actor Dennis Quaid for his roles in movies such as The Right Stuff and The Rookie. But since his infant son and daughter were mistakenly given a dangerously high dose of a blood thinner in 2007, Mr. Quaid also has become a patient safety advocate. (The twins have since recovered from that incident).

Not all patient safety advocates are movie stars, of course. But many have witnessed situations in which their family member was seriously injured or died due to a medical error. My agency, the Agency for Healthcare Research and Quality (AHRQ), and other groups want to change our health care system to prevent these errors.

The Quaids' experience put a spotlight on how to prevent drug errors in the hospital. Other groups, such as Consumers Advancing Patient Safety, seek to get patients more involved in working with health care organizations to stop medical errors.

Some hospitals are reducing the risk of medical errors by forming patient safety advisory councils. These councils serve as a bridge between hospitals and patients to increase communication between patients and health care professionals. They also allow the patient's point of view to be heard and, in some cases, to change existing practices.

With funding from AHRQ, Aurora Health Care, a large health system in Milwaukee, WI, developed a patient safety council of patients, doctors, nurses, pharmacists, and outside experts to reduce medical errors in the system's 100 outpatient clinics.

During the first council meeting in 2005, council members gave examples that showed big gaps in communication and understanding among doctors and patients. Doctors complained that patients were unable to describe the medicines they were taking, but some patients showed lists of medications they brought to all appointments. Other patients said they didn't worry about keeping their own lists because they assumed their doctor or nurse kept that information.

Based on that input, Aurora Health Care created and distributed personal medication lists and bags to patients. Patients were asked to use the bags to bring their medicines to appointments so their doctors would be clear about what medications they were taking. Patients who saw their doctor regularly were contacted once a year before an appointment and were reminded to bring their medicine list with them.

Aurora Health Care's community outreach showed positive results, according to a followup study. It showed:

• More accurate medicine lists for older patients. The accuracy of these lists among patients 55 and older improved from 55 percent before the education campaign to 72 percent afterward.
• High levels of patient involvement. More than three-quarters of patients 55 and older wrote down the medicines they received. And 73 percent brought the lists to their medical appointments.
• High levels of involvement by health care professionals. Surveys found that 85 percent of physicians, nurses, and pharmacists said that having patients bring in their medicine list made their records more accurate.

To help others create patient safety advisory councils, the team at Aurora Health Care outlined key steps in a guide that AHRQ published last year. The guide offers a range of practical advice, including suggestions on how doctors, nurses, and patients can talk to each other in an open and constructive way.

Creating a safer health care system, inside and outside the hospital, is a large and complex task. For change to be successful, patients need to be involved. Patient safety advisory councils can help us achieve this goal.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

More Information

Agency for Healthcare Research and Quality
Health Care Innovations Exchange
Community Collaboration Improves Accuracy of Medication Lists for Elderly Patients in Outpatient Clinic Setting
http://www.innovations.ahrq.gov/content.aspx?id=1766

Aurora Health Care
https://www.ahrq.gov/qual/pips/grants.htm#leonhardt

Consumers Advancing Patient Safety
http://www.patientsafety.org/