It has been 20 years since To Err Is Human first alerted the public about the prevalence of medical errors. The 1999 publication from the Institute of Medicine reported that 98,000 people were dying in American hospitals each year. The number shocked the public health community into action, but the problem remains far from solved.
With the risk of preventable harm in plain sight, researchers and policymakers have spent the intervening years trying to more accurately measure medical errors, diagnose how they occur, and establish systems and protocols to prevent them from happening.
Some studies have placed the annual number of medical errors far above that reported in To Err Is Human.
Review of Studies on Preventable Harm — 1 in 20 Patients Will Experience Medical Error
In order to quantify the number, type, and severity of medical errors, U.K. researchers from the Greater Manchester Patient Safety Translational Research Centre led by Doctor Maria Panagioti reviewed thousands of studies done in the last two decades on preventable harm.
Such large-scale reviews have been done on patient harm, but according to the researchers, “the prevalence of preventable patient harm has received less attention.”
Distinguishing preventable from unpreventable harm is not an easy task. Not everyone agrees on what counts as a medical error—this is the reason for such a wide range of estimates. When exactly does “failure to save” a patient become a medical mistake rather than an unavoidable outcome?
Panagioti’s team identified 70 studies with appropriate information, which involved more than 330,000 patients. From there, two reviewers working independently assessed the individual cases—was the adverse event something that could have been avoided? Disagreement in the reviewer’s assessment were adjudicated by the wider 4-person team.
After pooling and evaluating data from all the studies, Panagioti and her colleagues determined that roughly 1 in 20 patients seeking care will suffer a preventable harm. The total number of people experiencing harm in a care setting was roughly 1 in 10, and half of the time, such harm was classified as preventable.
In situations where preventable harm occurred, they found that 12% of patients experienced prolonged disability, permanent disability, or death. Most patient harm was related to drugs, other therapeutic treatment and was much more prevalent in intensive care or surgery.
The Overwhelming Cost of Medical Errors
According to the researchers, preventable harm in America accounts for an estimated $9.3 Billion in extra charges. They said that cost was equivalent to more than 2,000 salaried general practitioners or more than 3,500 hospital nurses. The sad irony here is that one of the chief causes of medical errors are burned out and overworked doctors and nurses.
The economic costs don’t even begin to take into account the medical and emotional burden experienced by a patient and their family in the wake of a serious medical error. Sometimes what ought to have been a routine operation turns into a months- or years-long nightmare.
Worse still are the experiences of families who lose a loved one, or deliver a newborn with injuries that should have never have occurred.
What Are the Causes of Medical Errors?
One finding that reoccurs in the literature on medical errors is that mistakes tend to result from a combination of events rather than a single point of failure.
While each adverse medical event is unique to the patient and their care team, there a number of circumstances which increase the likelihood of errors in the hospital:
Physician and Staff Burnout
According to the Department of Health and Human Services, physician burnout refers to, “long-term stress reaction marked by emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment.”
Physicians are responsible for the complex information contained in the charts of dozens of patients they oversee throughout the day. If their cognitive state is hampered by burnout, they can’t dedicate the necessary level of mental energy to the task at hand. Studies have as many as 78% of doctors affected, which has led some to call physician burnout a public health crisis.
Communication Issues
Every link along the so-called “chain of care” has to be strong. There are horror stories of doctors amputating the wrong leg, but other deadly communication issues are not as easy to identify. As a patient prepares for surgery, many specialists are consulted, and if they are not sharing information, or miscommunicating it, accidents may result.
Communication errors often happen during hand-offs and transfers. When a patient moves from one setting to another, or when working shifts change at the hospital, the new care team has to pick up where the old one left off. In a hospital environment, where doctors and nurses are responsible for the changing health conditions of multiple patients, such transfers introduce another layer of complexity to the chain of care.
Medication Administration
As Panagioti and her colleagues noted, “incidents relating to drugs and other treatments accounted for almost half (49%) of preventable harm.” Getting the proper dose of the correct medication to specific patients is vital, yet such errors in medication administration are estimated by the World Health Organization (WHO) to cost upwards of $42 Billion each year.
This is by no means a complete list of the reasons why medical errors occur. But it does give patients and their families a few areas to be aware of.
If you, or someone you care about, is one of the thousands of people who are affected by medical errors each week, you have legal rights that can help you secure the assistance you may need moving forward.
