1. Wallis, Laura


Collaborative unit management may be a solution.


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Approximately one in seven patients suffers from an adverse event as a direct result of a hospital stay, according to a report released in November 2010 by the Office of the Inspector General in the U.S. Department of Health and Human Services. The study, which looked at outcomes in Medicare beneficiaries discharged in October 2008, found that about 134,000 (13.5%) of the approximately 1 million patients hospitalized that month experienced adverse events-meaning some form of harm as a result of their medical care. Some of the events were unavoidable, such as surgical complications, but many (around 44%) were considered to be preventable, including hospital-acquired infections, medications administered in error, and even "never events" (adverse events that, in theory, should never occur) such as surgery performed on the wrong patient.


The events varied widely in severity. Some resulted in extended hospital stays; others led to permanent harm or even death. The associated costs to Medicare were $324 million in that month, equating to nearly $4 billion in a year.


In its recommendations, the report calls for holding hospitals accountable, more closely examining patient-safety issues, and requiring the adoption of evidence-based practice guidelines. (To read the full report, go to For nurses and the entire hospital community, the mandate to reduce preventable errors presents a considerable challenge.


Victoria L. Rich, chief nurse executive at the University of Pennsylvania Medical Center and associate professor of nursing and assistant dean of clinical practice at the University of Pennsylvania School of Nursing, sees the report as a call to action and believes nurses must be more vocal advocates for patients and actively collaborate with physicians to ensure the best possible care. "Most of what's published on patient safety focuses on physicians' practices," she says, "but the voice of the nurse must be an audible part of the process if we want to reduce errors."


At her own hospital, Rich and her colleagues have adopted a unit-based clinical leadership approach to patient care, in which each floor is managed jointly by a nurse manager, physician leader, and quality coordinator. By working in concert, the teams have been able to successfully lower the error rate and prevent many errors that do occur from worsening. It's an approach that increases the accountability of all members of the patient care team, and one that Rich advocates as a solution for increasing safety over the long term.


"As chief nurse, I work hard to make the voices of nurses as respected as physicians' voices," Rich says, adding that until that happens, the country's hospitals will continue to have an adverse event rate of one in seven.-Laura Wallis