Two decades ago, a landmark report from the Institute of Medicine found that thousands of patients die in hospitals each year from preventable medical errors.
In a new issue of Health Affairs devoted to that topic, an assortment of studies finds that hospitals have improved somewhat but have more work to do.
Among the studies was a survey at 535 hospitals in Pennsylvania, New Jersey, California, and Florida finding that 29.6 percent of nurses rated patient safety at those hospitals as "unfavorable."
Among other findings of that study, led by University of Pennsylvania nursing professor Linda Aiken:
54.9 percent of the nurses "would not definitely recommend their hospital."
28.9 percent gave their hospital an unfavorable grade on infection prevention.
37.3 percent said that "important information is lost" during shift changes.
41.9 percent said that "things fall between the cracks."
36.9 percent said that "staff do not feel free to question authority."
The number of nurses answering each question varied, ranging from about 12,900 to 13,500. Aiken, who is also the director of Penn's Center for Health Outcomes and Policy Research, was joined on the study by authors from Penn's Leonard Davis Institute of Health Economics, Rutgers University, the University of Delaware, and Emory University.
The researchers found some positive signs when comparing the results with what nurses said when asked the same questions in 2005. On average, nurses gave higher grades for quality of care and patient safety at hospitals where they said the "clinical work environment" had improved since 2005.
Work environment was evaluated based on factors such as the degree of managerial support for nurses, staffing levels, and amounts of resources and training.
At hospitals where nurses said the work environment had improved, researchers found a 15 percent jump in the number of nurses who gave the hospitals favorable grades on patient safety — defined as an A or a B.
But at hospitals where nurses said the work environment had worsened since 2005, researchers found a 19 percent drop in the number of nurses rating patient safety with an A or a B.
The report that prompted the national conversation about patient safety, titled "To Err Is Human," was published in 1999 by the Institute of Medicine, now called the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine. Among its recommendations were to improve the work environment for nurses by ensuring adequate numbers of staff.
In a news release, Aiken said the new survey shows that progress on that score has been uneven.
"Our recent study of nurses and patients suggests that those recommendations have not been uniformly adopted by hospitals," she said, "which may be hampering progress toward improving patient safety and preventing patient harm."