Why is it so difficult to assess the number of patients that are harmed by medical care errors in hospitals? And what can patients do to help make sure potentially harmful incidents are accurately reported?
A report published this month in the Journal of Patient Safety says that mistakes contribute to the deaths of some 440,000 hospital patients each year – roughly two to four times as many as previous estimates. Why the wide variance? As Marshall Allen of ProPublica reported via the NPR Shots blog, a number of studies have given vastly different numbers of fatality rates, including the Institute of Medicine’s (IOM) oft-quoted 1999 report, “To Err is Human.”
John T. James, PhD, a toxicologist at NASA, compiled numbers for the new study using a weighted average of four reports, including the IOM’s, and according to the Global Trigger Tool, a method of reviewing medical records. That total pointed to a lower limit of 210,000, but James theorizes that life-shortening errors of omission due to failure to follow medical guidelines, as well as diagnostic failures, are under reported. The real number of fatalities, he says, is more than twice that, comprising about one-sixth of all deaths each year in the U.S.
James wrote a book, “A Sea of Broken Hearts,” after the death of his son, which he claims is the result of preventable errors by a cardiologist unit. He also founded an advocacy group called Patient Safety America. The biggest reason for under reporting at an organization level, he maintains, is “the pride of not being willing to admit an error. Others are failure to recognize any error occurred and fear that your colleagues will know about your error,” he says.
While all parties would like to eliminate errors, James writes in the report, reducing medical errors in our complex and fragmented medical system can only be done with the help of patients, who are constants in this equation. As he says in the study:
All evidence points to the need for much more patient involvement in identifying harmful events and participating in rigorous follow-up investigations to identify root causes.Even for those harms identified in the medical records of Medicare patients, only 14% become part of the hospital’s incident reporting system.
He acknowledges that without a system overhaul, though, that will be difficult. “[Patients] may assume that harm is part of trying to get medical care. They may not know how to report errors or they may fear the confrontation that could be involved. I can tell you personally that loss of a child from medical errors leaves you devastated physically and emotionally. A survivor may simply not have the emotional reserve to deal with the system that, in my opinion, does a great job of protecting the one who made the error,” he says.
John James will be our featured guest in a live online conversation tomorrow as we explore the issues surrounding medical errors reporting. Marshall Allen (@Marshall_Allen), who reports often on patient safety issues, will moderate the group. Ask questions via Twitter using #GreatChallenges, and we’ll answer as many as we can on air. Click here to sign up.
Marshall Allen, Reporter, ProPublica and the ProPublica Patient Harm Community
John T. James, PhD, Chief Scientist of Space Toxicology, NASA Johnson Space Center
John Cox, Co-Founder, President and Chief Executive Officer, Visible Health, Inc.
Ana Hincapie, PhD, Assistant Professor of Clinical Sciences, California Northstate University College of Pharmacy
Michael Victoroff, MD, Executive Vice President and Chief Medical Officer, Lynxcare