Blue Cross and Blue Shield of Illinois Working Hard To Curb Medical Mistakes; Patients Play Key Role
Blue Cross and Blue Shield Association has 15 "preventable conditions" for which hospitals get no insurance payments
Chicago/Naperville, IL — "Patient safety" is the phrase defining all efforts to reduce medical errors — many made in hospitals. Very important in this campaign are patients themselves, says Dr. Carol Wilhoit, medical director of quality improvement at Blue Cross and Blue Shield of Illinois.
"Questions can help prevent errors before they happen," she says. "Imagine two women named Mary in the waiting room. The nurse comes out and asks for 'Mary' without using a last name. One responds and follows the nurse who gives her a shot. Afterwards, Mary asks why she got the shot, only to learn it was intended for the other Mary."
To prevent such errors, most medical facilities now confirm patient identities with first and last names and birth dates. Even so, patients continue to play a key role, too. "They must ask, 'Am I really supposed to get this test or treatment?' If things don't seem right, patients must speak up!" says Dr. Wilhoit.
If she's lucky, our imaginary Mary suffers no ill effects. But everyone isn't lucky. Healthy limbs are cut off. Surgical tools are left in patients. Some drug mix-ups are deadly. Serious infections are picked up in hospitals and other medical settings.Extent of problem
A major problem is healthcare-associated infections (HAIs), reports Dr. Carolyn Clancy, M.D., who directs the Agency for Healthcare Research and Quality (AHRQ), part of the U.S. Department of Health and Human Services.
"Healthcare-associated infections are acquired when patients are recovering from surgery or being treated for other conditions," said Dr. Clancy. "The most common complication of hospital care, HAIs contribute to 99,000 deaths every year and cost billions of dollars. We've made very little progress eliminating most HAIs in older patients." Post-surgery blood infections and those from urinary catheters are among the most common.
However, Dr. Clancy, a general internist and researcher, sees hope on the horizon. "One project AHRQ funded led to a near-total elimination of infections arising from central lines at more than 100 Michigan hospital intensive care units (ICUs). Another helped several Indianapolis, Ind., hospitals reduce MRSA infections in ICUs by 60 percent." MRSA is a germ whose full name is methicillin-resistant Staphylococcus aureus.
"Healthcare providers around the nation are learning from these approaches. My agency (www.ahrq.gov/consumer/cc 
) and others are spreading the word about how to use these strategies to get rid of other types of infections," said Dr. Clancy.
Patients play role
Both Drs. Wilhoit and Clancy emphasize the critical role patients play in reducing medical errors of all kinds. Here is a list of things to do when you're a patient:
- Make sure all your doctors know everything you take, including prescription drugs, over-the-counter medicines and dietary supplements like vitamins and herbs.
- Ask for information about your medicines in terms you understand completely, both when they're prescribed and when you receive them.
- If hospitalized, ask health care workers treating you if they've washed their hands.
- Upon discharge, ask your doctor to explain your home treatment plan thoroughly.
- If you're having surgery, make sure you, your personal doctor and the surgeon all agree on exactly what will be done.
- If you have tests, don't assume "no news" is "good news." Get the results.
- Finally, always speak up.
Dr. Wilhoit adds, "Patients who understand what type of testing or treatment is planned will know to ask questions. Questions can help prevent errors before they happen." Adds Dr. Clancy, "We have a saying at AHRQ: 'Questions are the answer.'"
Never events
On October 1, 2008, the Center for Medicare and Medicaid Services (CMS) stopped paying hospitals for 12 "preventable conditions," or "never events," acquired during hospital stays. Among them: pressure ulcers, blood incompatibility, foreign objects left in people after surgery, surgical site infections and falls and trauma (fractures, dislocations, burns and electric shocks).
Soon after, CMS added to the "never events" list surgery on the wrong body part, the wrong person and use of an incorrect surgical procedure. Following suit, the Blue Cross and Blue Shield Association in 2010 adopted all 15 "preventable conditions" as procedures and circumstances for which payments are not made by any Blues plan.
About Blue Cross and Blue Shield of Illinois
With nearly 7 million members, BCBSIL, a division of Health Care Service Corporation, a Mutual Legal Reserve Company, is the largest health insurance company in Illinois. Started in 1936, BCBSIL is committed to promoting the health and wellness of its members and its communities through accessible, cost-effective, quality health care. BCBSIL is an independent licensee of the Blue Cross and Blue Shield Association.
