Patients Beware: 1 out of 3 Subject To Hospital Error

Medical errors are one of the Nation’s leading causes of death and injury—the famed 1999 Institute of Medicine (IOM) study, To Err Is Human, estimated that avoidable medical errors contributed to 44,000–98,000 deaths at US hospitals annually.  Using the lower estimate,this suggests that more people die from medical errors than from fatal car crashes, breast or pancreatic cancer, or HIV/AIDS.

In November 2010, The Department of Health and Human Services (HHS) Office of Inspector General found that in  1 in 7 (13.5%) Medicare admissions experienced adverse events during their hospital stays. Further, for 1 in 70 Medicare admissions, the patient experienced an event that contributed to their deaths, which projects to 15,000 patients a month.  And that’s just Medicare!  (Sadly, Physician reviewers determined that over 40% were preventable. )

Also in November, an article in the New England Journal of Medicine NEJM reported on the first large study in a decade to analyze harm from medical care and to track it over time.  The study, conducted from 2002-2007 in 10 North Carolina hospitals, found that harm to patients was common and the number of incidents did not decrease over time.  The most common problems were complications from procedures or drugs and hospital-acquired infections.  The Harvard Medical School authors focused on North Carolina because its hospitals, compared with those in most states, have been more involved in programs to improve patient safety. [NYT Article]

So despite JAMA’s 2008 protest article suggesting that the medical error numbers were exaggerated, it appears that the situation is much worse than To Err is Human suggested. [Alternatively, an investigation by the Hearst media corporation, estimated preventable medical mistakes and infections to be responsible for about 200,000 deaths in the U.S. each year.]

The bottom line, patients have a basic expectation when they receive health care… that they will not be ‘harmed’ in the process…BUT hospitals can be dangerous.  Even good, hardworking people can (and do) make mistakes.  E-patients must be aware and engaged in everything that happens in the hospital. .. Your second set of eyes can make quite a difference.

What is a medical error? Medical errors happen when something that was planned as a part of medical care doesn’t work out, or when the wrong plan was used in the first place. Medical errors can occur anywhere in the health care system and can include errors that involve Medicines, Surgery, Diagnosis, Equipment and Lab reports.

The 1999 ‘To Err is Human’ study set off an urgent call for healthcare improvement.  In 2001, this brought an equally famed report, Crossing the Quality Chasm:  A New Health System for the 21st Century which outlined a comprehensive strategy and action plan to foster innovation and improve the delivery of care.

However, despite the intense efforts and improvements over the last decade, a new study published in April’s Health Affairs, estimates that medical errors may be 10 times more common than previous estimates—And errors may occur in as many as one-third of all hospital inpatient admissions. A second study in April’s Health Affairs estimates that the annual cost of measurable medical errors that harm patients was $17.1 Billion in 2008. Pressure ulcers, also known as bedsores but much more serious and painful, were the most common measurable medial error, followed by postoperative infections and by postlaminectomy syndrome, a condition characterized by persistent pain following back surgery.  A total of ten types of errors account for more than two-thirds of the total cost of errors, and these errors should be the first targets of prevention efforts.  [click here for the top medical errors and largest cost]

Many of you might be thinking, “is a bed sore really worth all of this fuss”?  A few years ago, I might have thought the same thing.  But after my diabetic father scratched his foot on a piece of coral off the coast of Australia that set off a deadly infection almost costing him his life and limb, and keeping him hospitalized for close to two years, he got a terrible pressure ulcer, or bed sore.  For  the two years my Dad was hospitalized, struggling with his leg, raw with infection that had spread from his ankle to his knee, what do you think bothered him the most? He’d lie in bed in a desperate state saying that his bedsore ulcers were the most painful part of his illness…He had months and months with terrible pressure ulcers that just wouldn’t go away and left him in constant pain and despair.  So when I look at these statistics, I cringe remembering the pain and agony my father faced…It’s not a statistic I can easily gloss over.

“Without doubt, we’ve seen improvements in health care over the past decade, and even pockets of excellence, but overall progress has been agonizingly slow,” said Health Affairs Editor-in-Chief Susan Dentzer.  “It’s clear that we still have a great deal of work to do in order to achieve a healthcare system that is consistently high quality—that is safe, effective, patient-centered, efficient, timely, and devoid of disparities based on race or ethnicity.”

So where does this leave us today? ”e-Patient Dave”deBronkart says, “Any patient or family member who wants to be responsible for their care needs to have their eyes wide open about the imperfections of health care delivery.  They have to understand that the best path to quality and safety is an open, empowered team approach; both goals are served by everyone realizing the full extent of the problem.”

What can patients and caregivers do to help prevent medical errors?

The single most important way to help prevent errors is to be involved in your healthcare, to be an active member of your health care team, and to take part in every decision. Research shows that patients who are more involved with their care tend to get better results. Based on the latest scientific evidence about what works best, the AHRQ outlines 20Tips To Prevent Medical Errors.  Here are a few of their recommendations:

  • Make sure that all of your doctors know about everything you are taking. This includes prescription and over-the-counter medicines, and dietary supplements.
  • Make sure your doctor knows about any allergies and adverse reactions you have had to medicines.
  • Ask for written information about the side effects your medicine could cause. If you know what might happen, you will be better prepared if it does—or, if something unexpected happens instead. A study found that written information about medicines can help patients recognize problem side effects and then give that information to their doctor or pharmacist.
  • If you have a choice, choose a hospital at which many patients have the procedure or surgery you need. Research shows that patients tend to have better results when they are treated in hospitals that have a great deal of experience with their condition.
  • If you are having surgery, make sure that you, your doctor, and your surgeon all agree and are clear on exactly what will be done. 
  • Speak up if you have questions or concerns.You have a right to question anyone who is involved with your care.
  • Ask a family member or friend to be there with you and to be your advocate.  I asked a nurse for her thoughts. Here is what NurseLoretta said, “The single most important way to help prevent errors is to have a family member with the patient at all times.  This is the best way to keep all the medical professionals on their toes and focused on the patient.”
  • Learn about your condition and treatments by asking your doctor and nurse and by using other reliable sources. For example, treatment recommendations based on the latest scientific evidence are available from the National Guidelines Clearinghouse™ at http://www.guideline.gov. Ask your doctor if your treatment is based on the latest evidence.

Many Patients’ Bill of Rights exist to support and guide patients.  Here are two examples: the Patients’ Bill of Rights for New York State and the American Hospital Association’s.

The Lesson: e-Patients and caregivers — get involved.  Medical Errors Are Not To Be Dismissed!

2 thoughts on “Patients Beware: 1 out of 3 Subject To Hospital Error

  1. There is some truth to “the squeaky wheel gets the grease”. I wonder what the statistics are for states that have passed hour limits on interns, has the better shift schedule resulted in reduced errors? What are the stats in countries like Canada or the UK where they have socialized medicine. It would be interesting to gain some context when considering this statistic. It is truly stunning. Almost scares you enough to eat nothin but fruits and vegetables :)

    • Interestingly or sadly, the study over many years in North Carolina showed no improvement despite much effort. it’s a bigger issue than people realize…but i don’t know about Europe. would be interesting to see if medical errors are less in a socialized medicine environment. Thanks for your comment!

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