Nightmare stories of nurses giving potent drugs meant for one patient to another and surgeons removing the wrong body parts have dominated recent headlines about medical care. Lest you assume those cases are the exceptions, a new study by patient-safety researchers provides some context.
Martin Makary, a professor of surgery at the Johns Hopkins University School of Medicine who led the research, said in an interview that the category includes everything from bad doctors to more systemic issues such as communication breakdowns when patients are handed off from one department to another.
“It boils down to people dying from the care that they receive rather than the disease for which they are seeking care,” Makary said.
The issue of patient safety has been a hot topic in recent years, but it wasn’t always that way. In 1999, an Institute of Medicine report calling preventable medical errors an “epidemic” shocked the medical establishment and led to significant debate about what could be done.
The IOM, based on one study, estimated deaths because of medical errors as high as 98,000 a year. Makary’s research involves a more comprehensive analysis of four large studies, including ones by the Health and Human Services Department’s Office of the Inspector General and the Agency for Healthcare Research and Quality that took place between 2000 to 2008. His calculation of 251,000 deaths equates to nearly 700 deaths a day — about 9.5 percent of all deaths annually in the United States.
Makary said he and co-author Michael Daniel, also from Johns Hopkins, conducted the analysis to shed more light on a problem that many hospitals and health-care facilities try to avoid talking about.
Although all providers extol patient safety and highlight the various safety committees and protocols they have in place, few provide the public with specifics on actual cases of harm due to mistakes. Moreover, the Centers for Disease Control and Prevention doesn’t require reporting of errors in the data it collects about deaths through billing codes, making it hard to see what’s going on at the national level.
The CDC should update its vital statistics reporting requirements so that physicians must report whether there was any error that led to a preventable death, Makary said.
“We all know how common it is,” he said. “We also know how infrequently it’s openly discussed.”
Kenneth Sands, who directs health-care quality at Beth Israel Deaconess Medical Center, an affiliate of Harvard Medical School, said that the surprising thing about medical errors is the limited change that has taken place since the IOM report came out. Only hospital-acquired infections have shown improvement. “The overall numbers haven’t changed, and that’s discouraging and alarming,” he said.
Sands, who was not involved in the study published in the BMJ, formerly known as the British Medical Journal, said that one of the main barriers is the tremendous diversity and complexity in the way health care is delivered.
“There has just been a higher degree of tolerance for variability in practice than you would see in other industries,” he explained. When passengers get on a plane, there’s a standard way attendants move around, talk to them and prepare them for flight, Sands said, yet such standardization isn’t seen at hospitals. That makes it tricky to figure out where errors are occurring and how to fix them. The government should work with institutions to try to find ways improve on this situation, he said.
Makary also used an airplane analogy in describing how he thinks hospitals should approach errors, referencing what the Federal Aviation Administration does in its accident investigations.
“Measuring the problem is the absolute first step,” he said. “Hospitals are currently investigating deaths where medical error could have been a cause, but they are underresourced. What we need to do is study patterns nationally.”
He said that in the aviation community every pilot in the world learns from investigations and that the results are disseminated widely.
“When a plane crashes, we don’t say this is confidential proprietary information the airline company owns. We consider this part of public safety. Hospitals should be held to the same standards,” Makary said.
Frederick van Pelt, a doctor who works for the Chartis Group, a health-care consultancy, said another element of harm that is often overlooked is the number of severe patient injuries resulting from medical error.
“Some estimates would put this number at 40 times the death rate,” van Pelt said. “Again, this gets buried in the daily exposure that care providers have around patients who are suffering or in pain that is to be expected following procedures.”
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