When the Institute of Medicine released the first of its reports on patient safety in 1999, it fell like a bombshell on the medical community. For the first time, the risk to patients in therapeutic settings had been quantified and laid out for public inspection.

That study, based on extrapolations, projected:

At least 44,000 Americans die each year as a result of medical errors [and] ... the number may be as high as 98,000. Even when using the lower estimate, deaths due to medical errors exceed the number attributable to the 8th-leading cause of death. More people die in a given year as a result of medical errors than from motor vehicle accidents (43,458), breast cancer (42,297), or AIDS (16,516).

In addition, the costs of preventable adverse events were estimated to be between $17 billion and $29 billion, with health care costs representing just over one-half of that figure.

The American Psychiatric Association appointed a task force to explore how errors impact psychiatric patients and what steps could be taken to improve the safety level of patient care. The task force presented a report that was approved by the APA board of trustees in November 2002 and by the assembly executive committee in January 2003. This year the APA is moving ahead with a three-pronged approach to minimize adverse events with the appointment of a committee to implement its recommendations. In some ways, the emphasis on safety is not new to the APA.

"Some parts of our patient safety concerns are issues that are more or less unique to psychiatry and that we have been dealing with for years," Paul Appelbaum, M.D., immediate past president of the APA, told Psychiatric Times. "For example, we have been concerned with the issue of patients hurting themselves, and that has led to development of standards for windows that don't break, shower rods that do break and so on. We've been way ahead of the field in this area, and our efforts predate the current patient safety movement."

"I want to be ambitious about this," said Alfred Herzog, M.D., vice president of medical affairs at Hartford Hospital. Herzog, who co-chaired the task force and is chairing the new committee, told PT, "I want us to make a difference, to have this be--in a positive way--that grain of sand in the oyster, to keep the pressure on, to have some pearls happen out of this, to have all of us buying into the patient safety culture."