Until last year, no one had issued a comprehensive assessment of the risk of patient harms associated with hospital care since a 1999 Institute of Medicine (IOM) study that used data from 1984. After 30 years, we finally have new information about how many deadly hospital errors, known in the medical world as lethal patient adverse events (PAE), occur yearly.
The study, conducted by John T. James, PhD in association with Patient Safety America, concluded that there are at least 210,000 deaths per year from preventable harm in hospitals, with the real number probably being closer to 400,000. This is well above the 1999 IOM estimate of 98,000. More stunning is the author’s conclusion that “serious harm” is 10-20 times more likely than lethal harm. The results are clear: in 30 years, it has become more dangerous, not less, to be treated as a patient at a hospital.
The author’s findings are based on a weighted analysis of the four most relevant small studies on patient harm between 2008 and 2011 that used the a reliable two-tiered research technique called Global Trigger Tool (GTT). Under GTT, trained investigators first comb through medical records for “triggers” such as medication stop orders, abnormal lab results, or prescriptions for “antidote”-type medications. Any flagged records are then reviewed by a physician to determine whether a PAE occurred how serious it was.
James and his team separated PAEs into five categories of errors: commission, omission, communication, context, and diagnosis. Most flagged records fell into the error of commission category – something a healthcare professional did that he should not have done – because it’s the easiest to identify. This is one reason the study emphasizes that the real number of deaths from medical errors is likely much higher than 210,000.
Before this analysis, researchers could not understand why small hospital study results didn’t match their predictions. For example, researchers expected outcomes in 10 North Carolina hospitals to be better than the national average because North Carolina has made concerted efforts to improve patient safety, but their findings suggested the hospitals were actually below average. By combining the four studies and weighting the results based on how many records were reviewed, James’ analysis provided a more accurate picture of average risk (North Carolina did end up having a better-than-average PAE rate).
How did hospital-based patient care get so bad, and how do we make it better? James lists complex medical technology; overuse and misuse of medication; and an industry focus on high-price, high-productivity, and high-revenue procedures as one piece of the problem. He states that outcomes could be greatly improved by more accurate and streamlined medical recordkeeping.
Researchers have found that up to a year after hospital discharge, patients recalled three times as many serious and preventable events than their medical records reported. A recent national survey of physicians showed that refusing to report adverse events – even when the physician had first-hand knowledge – is very common (2 in 3 cardiologists said they’d done it recently).
The bottom line is that we, as healthcare consumers, have to demand more of those in the healthcare industry because they clearly aren’t demanding more of themselves. As a medical malpractice lawyer, I strongly believe the Draconian tort reform laws enacted in many states including Virginia encourage negligent behavior. Reigning in tort reform across the country could be part of a larger solution to lower the rate of preventable patient harm in hospitals.