Alarming Trend: Medical Errors Have Increased in the U.S.

A new editorial in The Lancet medical journal cites staggering statistics that medical errors now occur in as many one-third of all U.S. hospitalizations.

The editors present other attention-getting statistics from several scientific studies establishing that medical errors remain a serious problem in the U.S. and appear to have increased over the last 10 years, despite national attention called to this problem.

The Lancet editors ask, “Why?” And, they make some suggestions that should well be considered by medical professionals, patients and caregivers, and policy makers in the U.S.

The Alarming Statistics:

The editorial, entitled, “Medical errors in the USA: human or systemic?“, appears in the April 16, 2011 Issue of The Lancet. It cites and describes the findings of several published studies on medical errors in the U.S. by recognized U.S. scientific and professional sources. Among them are the following:

• The US Institute of Medicine’s 1999 report, To Err is Human: Building a Safer Health System, estimated that avoidable medical errors contributed annually to 44,000—98,000 deaths in US hospitals. Hospital errors were reported to constitute the eighth leading cause of death nationally, accounting for more U.S. deaths than breast cancer, AIDS, and motor-vehicle accidents. This drew national attention to the problem.
• Yet, more than 10 years later, the problem of medical errors remains and seems to have increased. A new study reported in the April, 2011 issue of Health Affairs, found that by one measure, medical errors occur in as many as one-third of hospital admissions in the U.S., and may be ten times greater than previously measured. “The most common are medication errors, followed by surgical errors, procedure errors, and nosocomial infections,” according to The Lancet’s review of the study.

  The study, conducted by scientists and professionals at three leading U.S. medical schools as well as at the Institute for Healthcare Improvement, compared three different methods commonly used for measuring “adverse events” in hospitals: (i) voluntary reporting, (ii) the Agency for Healthcare Research and Quality’s Patient Safety Indicators (which rely on automated review of discharge codes to detect adverse events), and (iii) the Global Trigger Tool pioneered by the Institute for Healthcare Improvement (based upon independent review of medical charts, with follow up investigation where indicated).

  The study found that this third method measured at least ten times more confirmed serious medical errors than did the other two methods. As observed by The Lancet’s editorial, “This finding suggests that the two currently used methods for detecting medical errors in the USA are unreliable, underestimate the real burden, and also risk misdirection of present efforts to improve patient safety.”

• A study reported in the November 25, 2010 issue of the New England Journal of Medicine, also confirmed that medical errors in U.S. hospitals are a serious problem. The study, conducted by lead author Christopher Landrigan, M.D., M.P.H. of the Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, and a group of doctors from Harvard Medical School, Standford University School of Medicine, and the Institute for Healthcare Improvement, reported that even in places where local governments have made efforts to improve safety of inpatient care, such as in hospitals in North Carolina, the high rate of detected medical errors did not change over a 5-year period between 2002 and 2007.
• A November, 2010, document from the Office of the Inspector General of the Department of Health and Human Services reported that one in seven Medicare beneficiaries have complications from medical errors when hospitalized, and that these medical errors contribute to about 180,000 deaths of patients per year.
• A study by Jill Van Den Bos and other professionals of Milliman’s Denver Health practice reported in the April, 2011 Issue of Health Affairs found that the measurable cost of US medical errors amounted to US $17.1 Billion in 2008 (0.72% of the $2.39 trillion spent on health care that year). Ten types of error accounted for more than two-thirds of the total cost of medical errors. The top two most costly medical errors are postoperative infections and pressure ulcers. The three most common medical errors were pressure ulcers, post-operative infections, and postlaminectomy syndrome.
• Another study, conducted by John Goodman and associates of the National Center for Policy Analysis in Dallas, TX and also reported in the April, 2011 Issue of Health Affairs, reported that medical errors cause as many as 187,000 deaths in hospitals each year, and 6.1 million injuries, both in and out of hospitals in the U.S. This study estimated that the social costs, in lives lost and disabilities caused, from these medical errors amounted to between $393 Billion to $958 Billion in 2006, equivalent to 18% to 45% of total US health-care spending in that year. These authors recommended as a possible solution that patients should be “offered voluntary, no-fault insurance prior to treatment or surgery [so that they] would be compensated if they suffered an adverse event—regardless of the cause of their misfortune—and providers would have economic incentives to reduce the number of such events.”

The Lancet’s editors ask,

“Who or what is to blame for medical errors and their consequences?”

The potential causes they suggest could well be considered and addressed by U.S. medical providers and policy makers:

• “Overworked providers,
• An unnecessarily complex medical system,
• Uninformed patients?
• Patients are often handed from one doctor to another and, in the process, communication between providers can break down.
• Time spent filling out paperwork is time not spent with patients improving the quality of their care.
• Decision making often does not involve informing a patient about the balance between benefits and harms of individual treatments, or incorporating patients’ goals into planned treatment; and
• It does not help that existing guidelines allow medical residents in the USA to work on average 28 [hours] more per week than junior doctors in countries of the European Union.”

What can be done?

The Lancet’s editors observe that “US health providers and policy makers must make patients’ safety a national priority.”

They suggest, “A good start in the right direction will be to implement at the federal level a mandatory and comprehensive nationwide monitoring system to track medical errors.”

Read The Lancet’s Editorial, Medical errors in the USA: human or systemic? in The Lancet, April 16, 2011 Issue.

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