PCAST Report Urges Federal Leadership on Patient Safety
By Jay Kumar
A new report released this week to President Biden issued four recommendations to improve patient safety, including the appointment of a federal patient safety coordinator and requiring annual public reporting of “never events.”
The President’s Council on Advisors on Science and Technology’s (PCAST) Working Group on Patient Safety is co-led by Joe Kiani, chair and CEO of Masimo and founder of the Patient Safety Movement Foundation, and Eric Horvitz, chief scientific officer at Microsoft. The report is available here.
“Preventable medical errors take hundreds of thousands of lives each year. I am optimistic that these recommendations will help fast-track solving this critical problem that destroys so many lives,” said Kiani in a release. “It was an honor to work with such a distinguished cohort of fellow PCAST committee members on what we believe is an urgent mission, and I am grateful for everyone’s contributions. I know President Biden has been waiting for this report. He is our country’s biggest patient advocate and cares deeply about the very real suffering that happens every day across the U.S. healthcare systems due to medical errors.”
The group’s four recommendations are:
- Establish and maintain federal leadership for the improvement of patient safety as a national priority. This would include appointing a patient safety coordinator reporting to the president on efforts to transform patient safety among all relevant government agencies. It would also establish a multidisciplinary National Patient Safety Team and ensure inclusion of people from the most affected populations.
- Ensure that patients receive evidence-based practices for preventing harm and addressing risks. This includes identifying and addressing high-priority harms and promoting patient safety through the adoption of evidence-based solutions; also, requiring annual public reporting immediately and quarterly public reporting within five years. Evidence-based practices should be implemented and safety for healthcare workers and patients should be improved by supporting a just culture.
- Partner with patients and reduce disparities in medical errors and adverse outcomes. This should include implementing a “whole of society approach” in transforming patient safety and improving data and transparency to reduce disparities.
- Accelerate research and deployment of practices, technologies, and exemplar systems of safe care. This includes developing a national patient safety research agenda, harnessing revolutionary advances in information technologies, and developing federal healthcare delivery systems’ capacities and showcase results as exemplars for safer healthcare.
“This is a major milestone in healthcare safety in the United States, and if implemented, we believe it will influence and improve patient safety and healthcare worker safety around the world,” said Dr. Michael Ramsay, CEO of the Patient Safety Movement Foundation, in a release. “Since our inception, we understood that for long-lasting change to happen, it would require direction from the highest levels of government. These recommendations could not have come at a better time because WHO’s World Patient Safety Day is on September 17.”
Leah Binder, president and CEO of The Leapfrog Group, praised the PCAST report. “On behalf of the Leapfrog Group and the employers and purchasers who founded us, we applaud the President’s Council of Advisors on Science and Technology and its working group on patient safety for today’s groundbreaking report, which at long last puts a priority on one of the most devastating issues in American healthcare,” she said in a release. “The patient safety problem has been estimated to be the third leading cause of death in the country, exceeded only by cancer and heart disease, yet there is no one individual or government agency responsible for solving it. The patient safety problem is not impossible to solve—we know how to prevent these errors.”