As if we did not have enough to worry about with healthcare these days. Here is a new concern to add to the list — getting seriously or fatally injured in the hospital from a medical mistake or accident. Hard to believe with all our advances in science and medicine, but hospital errors now constitute the third leading cause of death in this country (behind heart disease and cancer). And it is a problem that seems to be growing despite all of the money being pumped into the system.
These were the findings of a just released study in the Journal of Patient Safety by John T. James, a PhD pathologist and Chief Toxicologist at NASA. He also runs the patient advocacy group Patient Safety America and is the author of A Sea of Broken Hearts, a book about the death of his 19-year old son from what James describes as “uninformed, careless and unethical” hospital care. Clearly, it would seem, Dr. James went into this study with a preconceived notion (and perhaps bias) of what he expected to find. Nonetheless, his conclusions are being taken very seriously in the medical community.
How he got there was by analyzing the data from four recent studies that used what is known as the Global Trigger Tool (GTT) to identify specific instances of hospital errors that led to actual patient harm. The GTT was created by the Institute for Healthcare Improvement and is used by hospitals to measure the prevalence of these so-called “adverse events.” It does this by flagging in patient records various indicators or clues — such as medication stop orders or abnormal lab results — that suggest the occurrence of an error in patient care.
Dr. James combed through these prior studies, synthesized the results, applied them across the total number of annual hospitalizations, and accounted for the numerous types of hospital errors that can rarely be detected. These would include diagnostic errors, errors not documented in medical records, and errors of omission such as a failure to follow medical guidelines. From all of this, Dr. James estimated that hospital errors result in 440,000 deaths a year in this country. This is roughly one-sixth of all U.S. deaths.
As shocking as this finding is, what is perhaps even more disturbing is the fact that it is more than four times the previous estimate. That came in 1999 from the Institute of Medicine’s (IOM) seminal publication To Err Is Human which estimated 98,000 annual deaths in the U.S. from hospital errors. This is the figure that, up until now, has been widely accepted by the medical community. So why the big increase? Part of it can be explained by flaws in the original IOM study and advances in detection provided by the GTT measuring stick.
According to Dr. James, however, part of the increase also may be explained by some of the central features that define the modern medical age in which we live:
[The] increased complexity of medical practice and technology, the increased incidence of antibiotic-resistant bacteria, the overuse/misuse of medications, an aging population, and the movement of the medical industry toward higher productivity and expensive technology, which encourages rapid patient flow and overuse of risky, invasive, revenue generating procedures.
This may be the most important finding that comes out of the James study. That despite our medical advances, we are heading in the wrong direction when it comes to patient safety. Or more pointedly, it is because of these advances that more people are dying from hospital errors.
The jury is still out on the validity of Dr. James’ results. According to an article in ProPublica, a spokesperson for the American Hospital Association said the group has more confidence in the original IOM estimate. However, several prominent physicians involved in patient safety disagree. One of them is Dr. Lucian Leape, a Harvard pediatrician known as “the father of patient safety” and one of the experts who worked on the To Err Is Human report. He told ProPublica the original IOM estimate was low and should be discarded and that the complexity of modern medicine is contributing to an ever-increasing number of medical mistakes.
But as Dr. James stresses in his report, any continuing debate on the precise number of deaths caused by hospital errors really misses the point: “it does not matter whether the deaths of 100,000, 200,000 or 400,000 Americans each year are associated with [hospital errors]. Any of the estimates demands assertive action on the part of providers, legislators, and people who will one day become patients.”
So does the fact that we are not just talking about preventable deaths here. This is also about avoiding all of the serious injuries that result from medical mistakes. According to Dr. James, serious harm in this context is likely 10 to 20 times more common than lethal harm. No matter how you slice it, the increasing prevalence of hospital errors has reached epidemic proportions. Hopefully, the James study will serve as a lightning rod to bring some much needed attention and action towards remedying this latest crisis in our healthcare system.
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