Health Care and Patient Safety

In ‘Notes on Hospitals’, Florence Nightingale begins with the following declaration: “It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm.”

What a chilling statement! If you examine it carefully, the implication is that the sick patient in a hospital is actually potentially susceptible to harm by the hospital which he actually visits with the expectation of being relieved of the harm that is caused by his disease. Looking at it another way, it says, a patient coming to a hospital also may possible be harmed by the hospital in a way that is not linked to his actual disease.

During her course of giving nursing services, Nightingale made several observations. She not only pioneered the concepts of modern nursing but was also an astute administrator, hospital designer, and statistician who introduced documented medical record-keeping from her observations which brought her to the statement that we are discussing. The germ theory (that germs are responsible for disease) was not yet accepted during her times. War injury soldiers were often treated by amputation of which fifty percent died at the point of time when the hygiene conditions in the makeshift barracks were appalling. They died due to infection. As many as eighty percents of soldiers undergoing surgery would have infections.

Today, because of the observations and trials of Nightingale (she reduced infection rates to as low as 2% during her times). Semelweiss (who demonstrated that simple handwashing reduced the number of post-delivery infections by as much as fifty percent), and Lister (who demonstrated that use of disinfectants reduced rates of post-surgery infection dramatically), modern medicine so rapidly achieved a level of sophistication and advancement which would have seemed unachievable to a person living in the 19th century. And hospital infection is only one of the factors that may cause harm to a patient.

We should not forget this. Medical advancement is directly proportional to the level of patient safety. This is therefore kept in mind in the building design and practices of the modern hospitals. Patient safety goals are prepared annually, hospital standards and guidelines like the NABH and JCI address patient safety in great detail and are the benchmarks that hospitals now need to follow.

So what is it that a hospital needs to do to keep patients safe? (adapted from Hospital National Patient Safety Goal: from the Joint Commission Accreditation for Hospitals)

Dr. Juri Bharat Kalita