Americans are increasingly worried about dangerous -- even deadly -- mistakes in hospitals, but an overwhelming majority say the solution lies in easy-to-read, published safety report cards, not more medical lawsuits, a national survey released yesterday found.
Five years after the Institute of Medicine (IOM) issued a landmark report on widespread preventable deaths in U.S. hospitals, the new poll shows that confidence in the health care system has declined and pressure to reform it has grown.
More than half of the 2,000 adults surveyed said they are dissatisfied with the quality of health care, up from 44 percent in 2000. At the same time, 92 percent said reporting of medical errors should be mandatory, according to the poll, by the Kaiser Family Foundation, the Harvard School of Public Health and the federal Agency for Healthcare Research and Quality.
Despite enormous frustration, few people indicated a desire to use the courts as recourse, calling into question policymakers' renewed interest in malpractice legislation, said Harvard pollster Robert Blendon.
"They do not view the malpractice system as the way to resolve these problems," Blendon said. "They would like the medical errors reported by a public agency, have the agency release it and then have it printed in some kind of Consumer Reports, and then they can go somewhere else" for care, he said.
About one-third of those surveyed said either they or a family member had experienced a medical error, but only 11 percent of them said they had sued for malpractice. By much larger margins, respondents favored remedies such as suspending the license of a doctor or nurse who makes medical errors.
In the 1999 report "To Err Is Human," the IOM estimated that between 44,000 and 98,000 people die in hospitals each year because of preventable mistakes. The errors range from operating on a wrong limb to spreading infection with dirty hands. Hospital-based errors are the eighth leading cause of death in the United States, claiming more lives than AIDS, automobile accidents or breast cancer.
"Unfortunately, despite five years of focused attention, people do not seem to feel safer," the researchers wrote in the New England Journal of Medicine. "In fact, 40 percent believe that the quality of health care has 'gotten worse' in the past five years."
Donald M. Berwick, president of the Massachusetts-based Institute for Healthcare Improvement, said it is impossible to say whether progress has been made because there are no universal standards.
"Impressionistically, substantial progress has been made on awareness," he said. Yet "most hospitals in this country do not have improvement of safety in their strategic agenda."
One major stumbling block is a dispute over whether hospital errors should be publicly released.
"Public reporting is not the answer" because it could create a climate of fear, said Don Nielsen, senior vice president for quality leadership at the American Hospital Association. Physicians want "definitive, useful, confidential reporting," he said.
But Carolyn Clancy, director of the federal agency devoted to improving medical care, countered: "Telling a patient about a medical error and what will be done in the future to prevent it should be the rule, not the exception."
Safety improvements can come in low-tech and high-tech changes, said Elliot Sussman, president of Lehigh Valley Hospital and Health Network in Pennsylvania. His hospital installed a $5 million computer system for ordering prescriptions and tracking patient care, and it placed hand-sanitizer dispensers in every room, reducing the rates of infection to far below the national average, he said.