Intended for healthcare professionals


Breaking the mould in patient safety

BMJ 2009; 338 doi: (Published 29 June 2009) Cite this as: BMJ 2009;338:b2585
  1. Laurent Degos, chair of board,
  2. René Amalberti, senior adviser (patient safety),
  3. Jean Bacou, head of international affairs,
  4. Jean Carlet, medical director,
  5. Charles Bruneau, senior adviser (accreditation)
  1. 1Haute Autorité de Santé (HAS), 2 avenue du Stade de France, 93218 Saint-Denis La Plaine Cedex, France
  1. Correspondence to: R Amalberti r.amalberti{at}

    To achieve real improvements in patient safety we need to look at the whole of patients’ care not just specific procedures, argue Laurent Degos and colleagues

    Patient safety currently revolves around hospital inpatients and has two approaches: adoption of well structured, standardised, evidence based treatment and a safe culture system (reporting, cooperation, etc) with checks and safeguards to reduce the occurrence of medical errors and adverse events. The aim is to avoid and prevent adverse events or injury through health care and to improve overall care.1 However, despite these interventions, almost 10% of hospital patients experience an adverse event and about 40% of events are preventable.2 3

    These high rates would doubtless be higher if out of hospital risks were included. We believe that the best way to reduce in-hospital risks is to start by reducing out of hospital risks that result in hospital admission. We argue that the current scope of patient safety is too restricted and should be extended to cover all obstacles to timely access to appropriate care.

    Impact of hospital interventions

    Current safety interventions are evaluated using patient safety indicators that have been selected for their feasibility of use and potential efficacy.4 Most indicators measure the frequency of adverse events such as surgical site infections, wrong blood type, drug related adverse events, patient falls, and postoperative pulmonary embolism. Other indicators address the causes of errors and assess processes such as the quality of medical records, prescriptions, and handover processes. These indicators are used in accreditation programmes and large scale campaigns inviting healthcare organisations to take part in quality improvement and benchmarking activities.5

    Improvements have been reported in health professionals’ acknowledgment of the importance of the quality and safety, their use of adverse event reporting systems and electronic charts, and the handling of dangerous materials and drugs …

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