[Improving patient safety: decreasing adverse events associated with medical care]

Awareness of the importance of what were previously called iatrogenic accidents is not new, but recent publications have demonstrated the frequency and severity of the accidents and incidents associated with care, which are now known simply as "adverse events". Research has helped us to understand the principal mechanisms underlying them and the circumstances that promote them. It shows that root causes, often linked to the organization of care, should be sought beneath the initial appearance of mistakes. Institutions providing health care must ascertain how to develop a new culture that makes it possible to improve patient safety by implementing new policies, that is, a group of several coordinated measures intended to decrease patient risk. These policies should use accepted techniques, such as reports and appropriate information management for events for which reporting is mandatory, but extended to medical accidents; critical activity analyses must also be used, for comparison with a standard, following the model used for evaluations of professional practices. New techniques are also necessary, such as operational feedback in the form of morbidity-mortality reviews and in-depth analyses of the most serious events. Institutions must establish indicators to prove the effectiveness of this new policy.