Medical Errors Stubbornly Common, Studies Find

It's been 11 years since the Institute of Medicine reported in December 1999 that medical errors caused more than 98,000 deaths and injured more than 1 million people each year. Unfortunately, the results from two recent studies indicate that—despite a lot of focus and effort—the nation's hospitals have not significantly reduced medical errors, which still lead to tens of thousands of deaths each year.

Hospital advocates don't dispute the findings, but they also don't believe the last 10 years were a lost decade. They believe that progress has been made, even if it is not immediately apparent.

"It was discouraging not to see more evidence that the hard work that has gone on in the past decade has had as substantial an impact as we believe it has. But the studies are what the studies are," says Nancy Foster, vice president for quality at the American Hospital Association.

"There are enormous numbers of hospitals engaged in a number of activities directly addressing patient safety issues. Are we there yet? No. It is a multifaceted problem that requires a multifaceted approach," she says. "We have to keep hammering at it until we get to the level of safety that we expect of ourselves and the public rightfully expects of us. As these studies suggest, we have a ways to go."

The studies—one from Health and Human Services Office of Inspector General, the other from the New England Journal of Medicine—indicate that medical errors remain widespread, common, and deadly. The OIG study found that one in seven Medicare beneficiaries suffers an adverse event during a hospital stay, and those events, nearly half of them preventable, contributed to at least 15,000 deaths in a single month.

The second study, published in the Nov. 25 issue of The New England Journal of Medicine, examined 2,300 randomly selected patients' records at 10 hospitals in North Carolina from 2002-2007 and found 588 instances of "patient harm," including surgical errors, hospital falls, misdiagnoses, medication errors, and hospital-acquired infections. Fifty of the incidents were considered life threatening, and 14 people died, according to the study.

Ironically, North Carolina was chosen for the study because of that state's recent emphasis on reducing medical errors. "It's a fair study. It points out that there is much more work to be done despite the fact that we have had some very intense efforts in this state over the last five years," says Don Dalton, vice president and spokesman for the North Carolina Hospital Association. "A little to our disappointment, the years of the study didn't coincide with some of our years of greatest improvement. We created a quality center here in 2005 so we have done a lot in the last five years and three of those five years would not have been included in the study."

Dalton says NCHA and its member hospitals have worked hard to reduce central line bloodstream infections and surgical site infection. "More importantly we have done a lot of work with hospitals around the issue of creating just cultures, where hospitals are taking greater responsibility for changes in the system that would eliminate the opportunity for harm, and healthcare professionals continuing to take personal responsibility for their actions. We feel like it is the system work that has the greatest opportunity to improve the quality of care," Dalton says.

In some respects, Foster says, the two studies' results also reflect the improving quality of data collection and identification of hospital errors. "What I see in these two studies is that we have learned an enormous amount about safety and our risks to patients, what might constitute an error and new ways to identify them which are much more robust than the original methodology used in the Harvard Medical Practice study which was the foundation of the IOMs original estimate," Foster says.

 "In addition we now see more things as potentially preventable than we did a decade ago," Foster says. "The biggest example is central line bloodstream infection. We used to think of them as having a certain level of inevitability and now we know we can get very close to zero with them. That's terrific news for patients but it does mean the count of things that are preventable has gone up."

See Also:
Hospital Infection Reporting Standards Inconsistent
A Call for Standardized Infection Detection Practices
Failure In Central Line Infection Prevention, Survey Says