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Hospital Patients, Beware


Like I said, hospitals are not safe places.

Patient advocates have long cited a landmark study, To Err is Human, published by the Institute of Medicine in 1999, which estimated that perhaps as many as 98,000 patients per year die as a result of hospital medical errors.   The study itself was based on New York State hospital data from 1984, 15 years before the study’s publication.  And for the last 15 years, that study has been widely cited for the proposition that malpractice is widespread.

But a new study suggests that the older research vastly underestimated the number of patients harmed by medical errors.  In A New Evidence-Based Estimate of Patient Harms, published in the Journal of Patient Safety, researcher John James estimates that the actual number of premature deaths resulting from preventable medical errors may be more in the range of 400,000 per year.

James surveyed the medical literature and identified four studies to use as the basis for his extrapolations.  The studies involved all used something called the Global Trigger Tool, an analytical model widely used by hospitals to identify medical errors based on a brief record review.  Based on those studies, he estimated that at least 210,000 patient deaths occur each year, simply from preventable errors that can be identified by the rather crude Trigger Tool method.

But that estimate is unquestionably far too low.  As James notes, the Global Trigger Tool is valuable for picking up many errors of commission–especially if the harm is recognized immediately.  But he lists a number of common types of errors that the Tool usually cannot identify: errors of omission, diagnostic errors, treatment errors resulting from failure to follow common guidelines or practices.  He also notes that, not uncommonly, medical records are written so as to make errors invisible or at least difficult to detect.

James chooses to account for all of those difficult-to-detect errors by multiplying the 210,000 deaths identifiable by the Global Trigger Tool by a factor of two (a multiplier based on other studies of preventable deaths), to reach a total of 410,000 deaths per year.  He then adds another 20,000 for undetected diagnostic errors.  The result is a staggering total of 440,000 preventable deaths per year–from hospital errors alone.  James doesn’t even attempt to calculate how many errors take place in out-patient settings, nor does he provide an estimate of the number of patients who are seriously injured by errors, but survive.

The discrepancy between the IOM’s 1999 estimate and James’ current estimate more than four times higher should be frightening to patients and patient advocates.  Even allowing for some underestimation by the IOM and some overestimation by James, it is clear that medical errors are on the rise.  Patient advocates need to realize that the current peer-review system that allows doctors and hospitals to conceal their mistakes from patients and families has done a great disservice to all involved.  Patients and providers alike need to work together to make hospitals safer.

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