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How Many Die From Medical Mistakes in U.S. Hospitals? ~Eric Geoffrey Von Leonard Plott~

How Many Die From Medical Mistakes in U.S. Hospitals?

 

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An updated estimate says at least 210,000 patients die from medical mistakes in U.S. hospitals a year. (File, Scott Olson/Getty Images)

 

It seems that every time researchers estimate how often a medical mistake contributes to a hospital patient’s death, the numbers come out worse.

In 1999, the Institute of Medicine published the famous “To Err Is Human” report, which dropped a bombshell on the medical community by reporting that up to 98,000 people a year die because of mistakes in hospitals. The number was initially disputed, but is now widely accepted by doctors and hospital officials — and quoted ubiquitously in the media.

 
 

In 2010, the Office of Inspector General for Health and Human Services said that bad hospital care contributed to the deaths of 180,000 patients in Medicare alone in a given year.

Now comes a study in the current issue of the Journal of Patient Safety that says the numbers may be much higher — between 210,000 and 440,000 patients each year who go to the hospital for care suffer some type of preventable harm that contributes to their death, the study says.

That would make medical errors the third-leading cause of death in America, behind heart disease, which is the first, and cancer, which is second.

The new estimates were developed by John T. James, a toxicologist at NASA’s space center in Houston who runs an advocacy organization called Patient Safety America. James has also written a book about the death of his 19-year-old son after what James maintains was negligent hospital care.

Asked about the higher estimates, a spokesman for the American Hospital Association said the group has more confidence in the IOM’s estimate of 98,000 deaths. ProPublica asked three prominent patient safety researchers to review James’ study, however, and all said his methods and findings were credible.

What’s the right number? Nobody knows for sure. There’s never been an actual count of how many patients experience preventable harm. So we’re left with approximations, which are imperfect in part because of inaccuracies in medical records and the reluctance of some providers to report mistakes.

Patient safety experts say measuring the problem is nonetheless important because estimates bring awareness and research dollars to a major public health problem that persists despite decades of improvement efforts.

“We need to get a sense of the magnitude of this,” James said in an interview.

James based his estimates on the findings of four recent studies that identified preventable harm suffered by patients – known as “adverse events” in the medical vernacular – using use a screening method called the Global Trigger Tool, which guides reviewers through medical records, searching for signs of infection, injury or error. Medical records flagged during the initial screening are reviewed by a doctor, who determines the extent of the harm.

In the four studies, which examined records of more than 4,200 patients hospitalized between 2002 and 2008, researchers found serious adverse events in as many as 21 percent of cases reviewed and rates of lethal adverse events as high as 1.4 percent of cases.

By combining the findings and extrapolating across 34 million hospitalizations in 2007, James concluded that preventable errors contribute to the deaths of 210,000 hospital patients annually.

That is the baseline. The actual number more than doubles, James reasoned, because the trigger tool doesn’t catch errors in which treatment should have been provided but wasn’t, because it’s known that medical records are missing some evidence of harm, and because diagnostic errors aren’t captured.

An estimate of 440,000 deaths from care in hospitals “is roughly one-sixth of all deaths that occur in the United States each year,” James wrote in his study. He also cited other research that’s shown hospital reporting systems and peer-review capture only a fraction of patient harm or negligent care.

“Perhaps it is time for a national patient bill of rights for hospitalized patients,” James wrote. “All evidence points to the need for much more patient involvement in identifying harmful events and participating in rigorous follow-up investigations to identify root causes.”

Dr. Lucian Leape, a Harvard pediatrician who is referred to the “father of patient safety,”was on the committee that wrote the “To Err Is Human” report. He told ProPublica that he has confidence in the four studies and the estimate by James.

Members of the Institute of Medicine committee knew at the time that their estimate of medical errors was low, he said. “It was based on a rather crude method compared to what we do now,” Leape said. Plus, medicine has become much more complex in recent decades, which leads to more mistakes, he said.

Dr. David Classen, one of the leading developers of the Global Trigger Tool, said the James study is a sound use of the tool and a “great contribution.” He said it’s important to update the numbers from the “To Err Is Human” report because in addition to the obvious suffering, preventable harm leads to enormous financial costs.

Dr. Marty Makary, a surgeon at The Johns Hopkins Hospital whose book “Unaccountable” calls for greater transparency in health care, said the James estimate shows that eliminating medical errors must become a national priority. He said it’s also important to increase the awareness of the potential of unintended consequences when doctors perform procedure and tests. The risk of harm needs to be factored into conversations with patients, he said.

Leape, Classen and Makary all said it’s time to stop citing the 98,000 number.

Still, hospital association spokesman Akin Demehin said the group is sticking with the Institute of Medicine’s estimate. Demehin said the IOM figure is based on a larger sampling of medical charts and that there’s no consensus the Global Trigger Tool can be used to make a nationwide estimate. He said the tool is better suited for use in individual hospitals.

The AHA is not attempting to come up with its own estimate, Demehin said.

Dr. David Mayer, the vice president of quality and safety at Maryland-based MedStar Health, said people can make arguments about how many patient deaths are hastened by poor hospital care, but that’s not really the point. All the estimates, even on the low end, expose a crisis, he said.

“Way too many people are being harmed by unintentional medical error,” Mayer said, “and it needs to be corrected.”

 

Errors are constantly being reviewed and corrected. You simply can not
avoid human errors.

How many are harmed by all the incorrect information published by the
press?

Working toward perfection is an honorable goal, but we will have to 
settle for excellence.

Hospitals in some states are required to report defined medical errors however the regulators sweep the errors under the carpet and rarely do they fully investigate these errors.  As for healthcare-associated infections, if the investigator knows nothing about how these infections occur they can not properly investigate them.

Excellent update on Dr. Leape’s report.

Like most negligent homicides and manslaughter suspects, we rely on doctors to self-report when their performance unnecessarily cripples or kills a patients.  For this reason, doctors are as likely to report preventable errors and complications as drunk drivers will self-report their intoxication.  Medical peers don’t report for the same reason that family members won’t report familial drunk drivers.

And unlike other industries whose products kill or injure consumers, preventable errors, complications and “adverse drug reactions” (ADRs) actually generate profits for hospitals.  So while patients define “good doctors” as those who keep us healthy, hospital administrators and academics define “good doctors” as those who generate profits.

Paradoxically, “tort reform” (something I once supported) dissuades patients and their survivors from filing claims against doctors, hospitals and the makers of vaccines and generic drugs, which dissuades hospitals from changing medical environments and services that threaten and injure patients.

For these reasons, I suspect that preventable errors, complications and adverse drug reactions are much higher than the estimated “third leading cause of death in the US.”  Until the US tort system is fully restored and an INDEPENDENT (not influenced by the healthcare, pharmaceutical or HHS) “black box” reporting system is established, preventable errors, complications and ADRs will remain what I suspect is the #1 leading cause of preventable death in the US.

Bruce J Fernandes

Sep. 19, 2013, 1:22 p.m.

And think about how many visitors to loved ones leave and subsequently get a hospital-borne infection.  I was one of them and there was no doubt on my doctor’s part that is the only place I could have gotten such an infection; it didn’t take a genius inasmuch as my wife got it and gave it to me.

There are no statistics accumulating that information either.  There should because there is a cost to visitors who get these infections too.

States are so understaffed they can barely carry out their inspection duties now and they have become more responsive in the aftermath rather than a precursor with a reporting function designed to pre-empt and prevent future outbreaks.

I joked last FEB when I went in for an elective procedure that maybe they should triage all of us out in an attached building outside the hospital before we enter.  Do all the disinfectant and related and then wheel us in through a corridor between buildings to dedicated elevators to operating rooms.

George Bernick

Sep. 19, 2013, 1:24 p.m.

How does this compare with medical delivery systems in Canada and the United Kingdom?

I do not know Clark Baker. but his perspective is “dead on” in my opinion.

Martha Deed, PhD

Sep. 19, 2013, 1:41 p.m.

John James’ analysis is a real contribution to understanding the reach of death by medical error.  Marshall, you have performed a valuatble service here by asking other experts to evaluate James’ methods and to lay out James’ findings in lucid lay terms.  Thank you very much!

The hospital association now acccepts the 1999 figure of 98,000 preventable deaths a year. That’s 11 dead patients a DAY, almost one every two hours. Initially, of course, the association dismissed the 1999 study - just as it now ridicules the new findings.

98,000 per year is 11 per hour, not 11 per day. *shock*

Suzan Shinazy

Sep. 19, 2013, 4:26 p.m.

Thank you John James! Yes, it is time for a national bill of patient’s rights. It is time the hospitals prove they can keep patients safe. It is time they show more math, numbers that prove your nurse and hospitalists really do have time for you;  time to keep you safe and time to give the excellent care that will return you to the best possible health.
BS7SDEN; do you really believe what you wrote? Are you the smoke blower or recipient?

but wait, there’s more.  a few years ago Don Berwick’s group said it had implemented reform that had eliminated approximately 100,000 deaths/year, which also sorta challenged the IOM numbers inasmuch as the Berwick group was much smaller.  In any event, there are a lot of avoidable deaths occurring in hospitals, which is a good reason for staying away from them whenever possible.  whether they’d rather clean up their act or dispute the numbers is an open question.  latter’s a lot easier.

Just another example of how the FDA and AMA are not protecting the public like they say they are. There would be dramatically less deaths in medicine if this was the case.

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