Imagine waking up to hear the news that somewhere in the United States, a jumbo jet full of people has just crashed, killing everyone on board - approximately 400 passengers. Now, imagine knowing that the equivalent of a jumbo jet full of people crashes somewhere in the U.S. every day. Sound like a bad dream? Unfortunately, it isn't. In fact, according to an analysis released by the health care quality company HealthGrades,1-3 up to 195,000 Americans die each year as a result of potentially preventable, in-hospital medical errors. That figure is nearly twice the number of annual medical error-related deaths published in a report by the Institute of Medicine (IOM) just five years ago, and makes medical mistakes the third-leading cause of death in the United States behind heart disease and cancer.
"The HealthGrades study shows that the IOM report may have underestimated the number of deaths due to medical errors, and moreover, that there is little evidence that patient safety has improved in the last five years," observed Dr. Samantha Collier, HealthGrades' vice president of medical affairs. "The equivalent of 390 jumbo jets full of people are dying each year due to likely preventable, in-hospital medical errors, making this one of the leading killers in the U.S."4
The IOM report, To Err Is Human, sent ripples through the American health care system when it was published in 1999. It examined the incidence of adverse events and medical errors that occurred in three states - Colorado, Utah and New York - along with extra costs due to lost income, lost production and other variables.
When the findings were extrapolated nationally, the authors estimated that between 44,000 and 98,000 preventable deaths were caused by medical errors each year, with an associated cost of more than $6 billion. The low estimate of 44,000 was shown to be higher than the annual number of deaths in the U.S. from motor vehicle accidents (43,458), breast cancer (42,297), or AIDS (16,516). The high estimate of 98,000 was criticized by some officials as being too low; one of the study's authors, Dr. Lucian Leape, was later quoted as saying that the IOM's numbers were based on a conservative definition of medical error, which could have dramatically underestimated the real number of deaths.5
The HealthGrades analysis examined billing information for 37 million Medicare patients hospitalized in all 50 states and the District of Columbia over the years 2000-2002. However, the HealthGrades authors used different criteria than the IOM study, and chose to focus on 16 types of patient safety errors defined by the Agency for Healthcare Research and Quality as "important," including an error called "failure to rescue," in which hospital staff fail to diagnose a disease in time, or fail to respond quickly enough to signs of infection or other dangerous conditions. The authors then estimated a national death rate based on the Medicare patients whose deaths could be attributed to those errors, using criteria from a 2003 Journal of the American Medical Association article on excess length of stay, charges, and mortality linked to medical injuries incurred during patient hospitalizations.6
Among the study's findings:
"This study identified a substantial number of patient safety incidents that resulted from failures in the processes of care in hospitals," the authors noted. They added that the frequency of adverse events uncovered in the study "may only represent the tip of the iceberg," because only certain types of injuries were analyzed, and because only a certain population (Medicare patients) was studied. "As such, we believe that our findings underestimate the true rates and associated costs of patient safety incidents in American hospitals."1
Dr. Kenneth Kizer, president and chief executive officer of the National Quality Forum, a Washington, D.C.-based organization that develops measurements for health care quality, echoed the authors' sentiments in an interview with the Boston Globe. "This should give you pause when you go to the hospital," Kizer said. He added that if the researchers had included errors reported at nursing homes, private practices and outpatient settings, the number of death attributable to medical errors would almost certainly have been higher.4
Developing guidelines that prevent medical errors from occurring is a daunting task that could take years to reach fruition, and requires a concerted effort from all members of the health care field. Until those guidelines are developed and implemented, the researchers suggest that practitioners and health care facilities focus their efforts on reducing four types of errors - failure to rescue, decubitus ulcers, postoperative sepsis, and postoperative pulmonary embolisms or deep vein thrombosis. According to the authors, "If we focused our efforts among Medicare beneficiaries on these four areas only, and were able to reduce excess attributable mortality and costs by just 20 percent, we would prevent almost 18,000 avoidable deaths and save Medicare and society $380 million in excess in-patient costs annually."1
"In conclusion, our results illustrate and validate previous studies that medical injuries in hospitals continue to be a real threat to Americans and are associated with significant negative economic consequences," the scientists wrote. "Most disturbingly, similar to previous study conclusions, these figures likely represent an underestimation of the true mortality and costs attributable to patient safety incidents within our U.S. health care system. As such, we recommend that more research be done to assess patient outcomes beyond death and costs, to understand circumstances and risk factors associated with medical injuries, and to develop strategies to prevent medical injuries."1
The HealthGrades report, Patient Safety in American Hospitals, is available online at www.healthgrades.com/media/english/pdf/HG_Patient_Safety_Study_Final.pdf. Doctors of chiropractic are encouraged to download and print a copy of the report for their own reading and to share with their patients.
References
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