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5 Scary Things About Healthcare Quality

Cheryl Clark, for HealthLeaders Media, October 31, 2013

Despite stringent hospital protocols and watchful government agencies, preventable medical errors continue to severely harm or cause death to some 400,000 patients a year in this country.

Sometimes stories about medical harm are especially creepy and bizarre, especially when incidents that should by now have been made impossible happen anyway.

It gives me nightmares to think that despite the most diligent precautions by providers, wrong site surgeries, retained foreign objects and other tragic medical errors cause avoidable death to some 400,000 patients a year in this country. Still.

Today is Halloween, a time when we honor the dead. In Mexico, as in some parts of the U.S., November 2 is called Día de Muertos. In healthcare, it may also be a time when we think about those patients who, but for some unfortunate confluence of regrettable snafus, would still be alive.

Here are a few recent news items that I find particularly unsettling.

1. Medical Errors Account for 440,000 Deaths a Year

First on my list is a most fearsome paper by John T. James in the September issue of the Journal of Patient Safety. James, a pathologist with Patient Safety America in Houston, analyzed multiple studies to draw this eye-opening conclusion:

Providers are greatly under-reporting patient deaths that result from their medical errors. He says that at least 210,000 deaths a year in the U.S.—and as many as 440,000—can be blamed on provider mistakes, mostly occurring in hospitals. That's more than four times the amount estimated by the Institute of Medicine's 1999 report, To Err Is Human.

James counted errors not just of commission, such as the administration of an incorrect drug or dosage, but of omission, communication, diagnosis, and context (such as when physicians fail to consider a patient's limited cognitive abilities to comply with medical treatment).

He also counted not just those in-hospital deaths resulting from those errors, but deaths that occurred months after patients left the hospital.

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3 comments on "5 Scary Things About Healthcare Quality"


Suresh Nirody (11/1/2013 at 2:53 PM)
He didn't actually "count" anything... He looked at four studies(covering 4,252 records reviewed, which were associated with a total of 38 deaths) and then extrapolated their rates to the total 34.4 million discharges in 2007 to get his lower boundary... Beyond the deaths he estimates a mind-boggling 2-4 million serious adverse events (not resulting in death) a year! What IS shocking is that the 1999 IOM report was based on data from studies in 1984, and this latest report is based on years old data as well. It is an indictment of the system that analysis of something so important has to rely on such old data! Also, given the magnitude of the numbers discussed, I've been completely amazed to NOT have seen any analysis of this report, either to support or to disagree with the methodology and his numbers and conclusions... Surely there are learned people who can, and should, do this!

Lisa Sams MSN, RNC (11/1/2013 at 1:27 PM)
Cheryl, thank you for highlighting the James article. The doctor consider "father" of patient safety is confident in the analysis. And you raise an important question about the level of interest in harm and death that occur during a hospital stay. Unless it happens to someone we know....or to ourselves....I believe we have learned to ignore the data because it is One Person at a time. Many attempt to tell their story and organizations like the Walking Gallery offer visual representation of lost or harmed loved ones. These are system issues, as mentioned in other comment. But calling it a system problem does not remove the provider, administrator and other staff from the analysis. As a long time advanced practice nurse, I see the value in system analysis and development of a plan that can be tracked until the culture change is truly integrated into care. If we can reach critical mass with patient communities and clinicians sharing information, collaborating and basically taking charge of the problem it will change. No clinician goes to work looking to cause harm and when it happens it is devastating. It is time to share basic information with patients and families in how to stay safe in the hospital, to push back, to question and when necessary engage the CEO through a Risk Management report...done on a scrap of paper is all it takes. Yes, these are complex system issues but if your spouse, your mom or your child is not receiving the care you think they should then push and push hard. We have a good history of patient community driving change in the 60's & 70's. It was women who changed our closed doors and drug induced hospital births to family centered care. They became educated and expected more.

stan davis (10/31/2013 at 7:15 PM)
very irresponsible to write "He says that at least 210,000 deaths a year in the U.S.[INVALID]and as many as 440,000[INVALID]can be blamed on provider mistakes". nowhere in the paper does it state this as "provider mistakes". the errors are part of a system, and requires a system approach to fix.