AAO initiatives put focus on patient safety

Chicago-Recognizing that healthcare errors impact one in every ten patients around the world, the World Health Organization has called patient safety an endemic concern, said Richard L. Abbott, MD, at AAO 2016.

As the lead-off speaker in a symposium on safety in the clinic and the operating room, Dr. Abbott presented data highlighting the scope of the problem in ophthalmology and talked about the patient safety initiative of the American Academy of Ophthalmology (AAO).

“Our challenge today and going forward is to build a culture of safety in ophthalmology,” said Dr. Abbott, Thomas W. Boyden Endowed Chair in Ophthalmology, University of California at San Francisco.

Dr. Abbott explained that patient safety has emerged as a new healthcare discipline that emphasizes the reporting, analysis, and prevention of medical error that often leads to adverse healthcare events.

“Serious mistakes are made in diagnosis, prescribing of medications, communication, and surgery, and we need some data so that we know the most harmful ambulatory safety issues in order to create and implement a corrective plan with achievable goals,” he said.

As evidence of the mistakes, Dr. Abbott presented data from the IRIS Registry showing that between 2013 and 2014, of the almost 6.5 million patients captured in the database, 0.71% had a medical error, translating into about 4,600 events. Cataract fragments left in the eye accounted for the vast majority of those errors (n = 4498), and he noted that the importance of cataract surgery has to do with the volume of procedures performed.

“We are now looking at a total of 20 million unique patients in the database, and so these numbers are much greater and we are dealing with a significant problem,” Dr. Abbott said.

“We hope the IRIS Registry will give us more information and help us pinpoint where the medical errors occur.”

Presenting medical malpractice claims data from the Ophthalmic Mutual Insurance Company (OMIC), Dr. Abbott said there have been more than 4,000 closed claims and lawsuits in the database since 1987. Again, as would be expected based on relative case volume, the largest percentage of claims and of paid claims involved cataract surgery.

Improper performance of surgery accounted for over 50% of the claim allegations, while diagnostic error was the allegation in almost 14% of claims.

A look at indemnity paid showed diagnostic error assumed even greater importance, while eight of the top ten largest claims paid by OMIC over the past years had to do with misdiagnosis or diagnosis failure and diagnostic error.

“This means there is more financial reward given to patients where there is a diagnostic error. Therefore, in looking at our education and in the ways we practice, diagnosis is a key issue in patient safety,” Dr. Abbott said.

Spearheading patient safety

Spearheading patient safety

“We think we have a unique opportunity in ophthalmology, and the AAO is working with many organizations both in the United States and globally to build a culture of patient safety. We have a very strong interest in leading efforts to improve patient safety and avoid medical errors in the clinical practice setting,” Dr. Abbott said.

He noted that the AAO is working with the American Board of Ophthalmology to build a culture of patient safety. In addition, at the 2015 annual meeting of the AAO, the Global Alliance Secretariat chaired a meeting in which international ophthalmology leaders discussed the best ways to proceed in building a global patient safety culture, and the group was convening again on Monday, October 16, 2016.

Other components of the AAO’s patient safety initiative include patient safety symposia being offered at the annual meeting, all Supranational Society meetings in 2017, and the World Ophthalmology Congress in 2018.

A host of other resources related to patient safety are also available from the AAO.

In addition to the IRIS Registry, they include the Preferred Practice Pattern guidelines, technology assessments, patient safety statements, patient educational materials, and risk management tips from OMIC.