The Society of Cardiovascular Anesthesiologists' FOCUS initiative: Locating Errors through Networked Surveillance (LENS) project vision.

Peter J. Pronovost, MD, PhD* BACKGROUND Although the methods to measure preventable harm are imprecise and immature, preventable harm is one of the leading causes of death, disability, and increased costs of care. The field of anesthesiology has been recognized for its efforts to improve patient safety, but much work remains to reduce harm to patients having cardiac surgery. Despite significant publicity regarding patient safety and efforts to improve it since the publication of To Err Is Human 10 years ago, there is little empiric evidence that health care is safer. For example, reports of wrong-site surgery continue to increase year after year despite a national patient safety goal* and widespread efforts intended to reduce such events. Although the true increase in wrong-site surgery is debated and may represent reporting bias, we clearly have not eliminated this sentinel event or other events for which there are data. One logically asks why a country that spends more than 2 trillion dollars a year on health care, 17% of its gross domestic product, continues to produce significant preventable harm. Why do wrong-site surgeries and other adverse events continue despite substantial efforts by regulators, hospitals, and professional societies? The problem is complex and implementing solutions has been exceedingly difficult. However, the solution is conceptually simple: we must adequately develop and apply rigorous science to analyzing errors in the delivery of health care. For example, despite there being a national policy to prevent wrong-site surgery, there are little to no data showing the effectiveness of this intervention. Few quick fixes will improve safety. Similar to biomedical science, safety improvements will require a robust and disciplined science that matures over time. Perhaps the greatest barrier to measurable progress in patient safety is the inability to evaluate with scientific rigor whether patient safety interventions are effective. This is the result of insufficient research funding and, paradoxically, the interdisciplinary nature of patient safety. There is sparse research funding for “basic science” in patient safety, especially to develop measures and tools to improve it. As a result, measures are often of poor quality, and the interventions of limited effectiveness, if not harmful. There are many disciplines that inform the science of patient safety, including organizational sociology and industrial psychology, clinical medicine, human factors engineering, health services research, economics, epidemiology, biostatistics, and informatics. Each discipline views the world through a unique “lens” and has a different frame of reference for viewing various aspects of patient safety risks and interventions as compared with others. Unfortunately, these lenses are From the *Departments of Anesthesiology & Critical Care Medicine and Pediatrics, The Johns Hopkins University School of Medicine and the †Department of Health Policy & Management, Bloomberg School of Public Health, Baltimore, Maryland. Accepted for publication October 5, 2009. Supported by the Society of Cardiovascular Anesthesiologists (SCA) Foundation for the LENS Project. Elizabeth A. Martinez was supported by the Agency for Healthcare Research and Quality K08 grant #HS013904-02. The FOCUS Initiative is a collaborative project of the Society of Cardiovascular Anesthesiologists, the SCA Foundation, and the Johns Hopkins University Quality and Safety Research Group. FOCUS is funded exclusively by the SCA Foundation. Address correspondence and reprint requests to Peter J. Pronovost, MD, PhD, The Johns Hopkins University School of Medicine, 1909 Thames St., Second Floor, Baltimore, MD 21231. Address e-mail to [email protected]. Copyright © 2010 International Anesthesia Research Society