Survey Results: Doctors' Patient Safety Efforts Blocked by Many Obstacles

TAMPA, Fla. -- One doctor says his hospital is "reusing disposable instruments in the operating room to save a little money." Another acknowledges that radiologists order additional tests for a patient even if the diagnosis is confirmed: "It's clearly a way of making additional revenue."And one physician says his hospital's young chief operating officer once compared the hospital to a donut shop. The COO told the physician: "We are like a donut shop. Our job is to sell donuts. If  we don't sell a lot of donuts we go out of business. Your job, as chief of emergency services, is to convince patients they need to be in the hospital and to convince doctors they have to admit patients. It is not your job to decide if the admission is good for patients."

Those are just a few of the thousands of comments shared by physician leaders across the country who filled out the American College of Physician Executives' 2007 Quality of Care Survey. The survey was completed by 1,155 physicians in hospitals, group practices, and other healthcare organizations. It explored a wide range of quality and patient safety issues, particularly the obstacles physicians encounter as they try to improve patient care.

Money was among the top four obstacles identified by the physicians:

1. Lack of resources and money

2. Patient compliance and awareness of healthy habits

3. Poor communication among physicians, nurses and paraprofessionals

4. A desire to maintain the status quo

About 20 percent of physicians in the survey said decisions about quality and patient safety frequently favor the organization rather than what's best for the patients.

Among the hundreds of other cost-cutting moves that impact patient care that were pointed out by the survey participants included:

-- "War readiness occasionally trumps patient care and quality in a military setting."

-- "[We] discharge of patients prematurely because the hospital will lose money."

-- "We really need to upgrade our defibrillators for safety reasons but due to finances this was nixed."

Physicians in the survey indicated that one of the most pervasive problems affecting good care is patient flow, often involving huge backups in the emergency departments.

"The hospital is overcrowded, resulting in closure of the ED to new patients 30 percent of the time," one physician wrote.

"Patients are kept in the ED holding beds for up to two days, waiting for beds in the hospital. More inpatient beds are available, but floors are kept closed because staffing them would cost too much."

The survey was conducted in February and the results are being published in the May/June issue of The Physician Executive Journal of Medical Management, published by the American College of Physician Executives.

Source: American College of Physician Executives (ACPE)

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