Improving Safety in Health Care: Beyond Standard Hospital-Acquired Conditions

Patient safety efforts have largely focused on reduction of events collectively called hospital-acquired conditions (HACs). These events include device-related events such as central line–associated bloodstream infections and catheter-associated urinary tract infections, immobility and pressure injuries, other hospital acquired infections, falls, and readmissions. This review will discuss causes of harm beyond traditional HACs. The authors hope to raise awareness that to achieve further reductions in patient harm events, physicians must play an increasingly active role in improvement efforts. Diagnostic error is a significant source of patient harm for all ages and healthcare settings. Hospital-acquired kidney injury occurs in children, may lead to chronic renal dysfunction, and can be mitigated by limiting the use of nephrotoxic medications and monitoring of creatinine in exposed patients. Adoption of restrictive red blood cell transfusion practices decreases transfusion-related harm by decreasing the number of exposures. Further reductions in patient harm will require active engagement of physicians and other providers to understand how practice habits and the systems in which we practice contribute to harm and implement strategies that will bring about changes in how we function as individuals, within teams and within systems. It is unlikely that continuing to focus on improvement project by project (HACs) will significantly reduce harm events.