Learning Accountability for Patient Outcomes

The U.S. health care culture allows physicians to go unquestioned when their behavior puts patients in harms way.

Each year thousands of patients die from preventable infections, such as central line-associated bloodstream infection (CLABSI). CLABSI causes 31,000 patient deaths per year. An intervention implemented in more than 100 intensive care units in Michigan reduced CLABSI cases by 66 percent; other interventions have achieved similar results.

In this commentary, published by JAMA, Peter J. Pronovost asks why hospitals have not done more to reduce preventable infections like CLABSI. Dr. Pronovost cites CLABSI as a good starting point for improving patient safety. He calls for improving teamwork among hospital staff. Most concerning to Dr. Pronovost is widespread arrogance among physicians who believe themselves infallible. The author relates his own experience with a physician who ignored a patient’s latex allergy.

Key Findings:

  • Despite the secretary of the Department of Health and Human Services calling for a 50 percent reduction in CLABSI over three years, in many states less than 20 percent of hospitals have volunteered to participate.
  • Almost all nurses would not speak up if they saw a senior physician placing a catheter but not complying with a CLABSI prevention checklist.
  • Clinicians and hospital leaders have different responsibilities in preventing CLABSI. In addition, there must be public reporting about the issue.

In this commentary, Dr. Pronovost calls for greater accountability for patient safety within the U.S. health care system. He emphasizes the role of teamwork in reducing CLABSI and other preventable infections.