This guest post by SPM member Ellen Hoenig Carlson was inspired by a study on the prevalence of medical errors, published in the April issue of Health Affairs.
Medical errors are one of the nation’s leading causes of death and injury. The famed 1999 Institute of Medicine study, “To Err Is Human,” estimated that avoidable medical errors contributed to 44,000–98,000 deaths at US hospitals annually. Using the lower estimate, this suggests that more people die from medical errors than from fatal car crashes, breast or pancreatic cancer, or HIV/AIDS. Even if the numbers are exaggerated, as a 2008 JAMA article suggested, any death that could have been prevented is a tragedy. (Alternatively, an investigation by the Hearst media corporation, estimated preventable medical mistakes and infections to be responsible for about 200,000 deaths in the US each year.)
The bottom line is that patients have a basic expectation when they receive health care: That they will not be harmed in the process.
What is a medical error? Medical errors happen when something that was planned as a part of medical care doesn’t work out, or when the wrong plan was used in the first place. Medical errors can occur anywhere in the healthcare system and can include errors that involve medications, surgery, diagnosis, equipment, or lab reports.
The 1999 “To Err is Human” study set off an urgent call for healthcare improvement. It was followed in 2001 by an equally famed report, “Crossing the Quality Chasm: A New Health System for the 21st Century,” which outlined a comprehensive strategy and action plan to foster innovation and improve the delivery of care.
However, despite the intense efforts and improvements over the last decade, a new study published in the April 2011 issue of Health Affairs estimates that medical errors may be 10 times more common than previous estimates. And errors may occur in as many as one-third of all hospital inpatient admissions. A second study in April’s Health Affairs estimates that the annual cost of measurable medical errors that harm patients was $17.1 billion in 2008. Pressure ulcers, also known as bedsores, were the most common measurable medial error, followed by postoperative infections and by postlaminectomy syndrome, a condition characterized by persistent pain following back surgery. A total of 10 types of errors account for more than two-thirds of the total cost of errors, and these errors should be the first targets of prevention efforts. (Click here for a list of the top medical errors and highest costs; a paid subscription to Health Affairs is required to view it.)
Many of you might be thinking, “Is a bedsore really worth all of this fuss?” A few years ago I might have thought the same thing. But after my diabetic father scratched his foot on a piece of coral off the coast of Australia, setting off a deadly infection that almost cost him his life and limb, he got a terrible pressure ulcer, or bedsore. For close to two years my Dad was hospitalized, struggling with his leg, raw with infection that had spread from his ankle to his knee. But, what do you think bothered him the most? He’d lie in bed in a desperate state saying that his bedsore was the most painful part of his illness…He had months and months with this terrible pressure ulcer that just wouldn’t go away and left him in constant pain and despair. So when I look at these statistics, I cringe, remembering the pain and agony my father faced — it’s not a statistic I can easily gloss over.
“Without doubt, we’ve seen improvements in healthcare over the past decade, and even pockets of excellence, but overall progress has been agonizingly slow,” said Health Affairs Editor-in-Chief Susan Dentzer. “It’s clear that we still have a great deal of work to do in order to achieve a healthcare system that is consistently high quality — that is safe, effective, patient-centered, efficient, timely, and devoid of disparities based on race or ethnicity.”
So where does this leave us today? According to e-Patient Dave deBronkart, “Any patient or family member who wants to be responsible for their care needs to have their eyes wide open about the imperfections of health care delivery. They have to understand that the best path to quality and safety is an open, empowered team approach; both goals are served by everyone realizing the full extent of the problem.”
What can patients and caregivers do to help prevent medical errors?
The single most important way to help prevent errors is to be involved in your healthcare, to be an active member of your healthcare team, and to take part in every decision. Research shows that patients who are more involved with their care tend to get better results. Based on the latest scientific evidence about what works best, the AHRQ outlines 20 Tips To Prevent Medical Errors. Here are a few of their recommendations:
- Make sure that all of your doctors know about everything you are taking. This includes prescription and over-the-counter medicines, and dietary supplements.
- Make sure your doctor knows about any allergies and adverse reactions you have had to medicines.
- Ask for written information about the side effects your medicine could cause. If you know what might happen, you will be better prepared if it does — or, if something unexpected happens instead. A study found that written information about medicines can help patients recognize problem side effects and then give that information to their doctor or pharmacist.
- If you have a choice, pick a hospital at which many patients have had the procedure or surgery you need. Research shows that patients tend to have better results when they are treated in hospitals that have a great deal of experience with their condition.
- If you are having surgery, make sure that you, your doctor, and your surgeon all agree and are clear on exactly what will be done.
- Speak up if you have questions or concerns. You have a right to question anyone who is involved with your care.
- Learn about your condition and treatments by asking your doctor and nurse and by using other reliable sources. For example, treatment recommendations based on the latest scientific evidence are available from the National Guidelines Clearinghouse at http://www.guideline.gov. Ask your doctor if your treatment is based on the latest evidence.
Patients, get involved. Medical errors are not to be dismissed!
This brings me back to when I was at Stanford hospital following a hip replacement 2years ago. Somehow in their fancy shmancy EPIC EHR it got nearly permanently noted that I was on methadone, which I wasn’t. This is even after I told them I wasn’t on methadone. This is a true story. Their pain management team had once recommended methadone for my bone pain, but I said no. And, even after I told their inservice pain management team that I had not taken methadone, they still had it recorded that I was on it upon discharge. Boy did I raise hell, and that is not a pretty picture (ask my husband). This is not what a hip replacement patient should have to deal with. Thankfully this was not a life and death issue, except for the drugs that I was going to be on….what mess…So, buyer beware is the message.
This may sound overly nuanced, but my expectations aren’t necessarily that I won’t be harmed while receiving care. Risk is inherent in everything, and patients need to understand that there are tradeoffs, i.e. chemotherapy that can save your life but also can lead to complications, unwanted side effects and long-term aftereffects.
My expectation is that clinicians will do everything they can to avoid *preventable* harm, and that if harm occurs, preventable or otherwise, they will respond promptly, competently and respectfully to avoid further damage.
Hi Anne – nice to meet you!
I imagine the point here isn’t what we expect – of course we all expect to be treated competently, carefully, thoughtfully. The whole point of this post seems to be that any empowered, engaged patient, who wants to do what they can to help their own cause, should have their eyes WIDE open about the fact that reality is nowhere near what our expectations say it should be.
What I’m trying to convey, I guess, is that awareness of risk should be part of every informed patient’s knowledge base. So yes, I completely agree with Ellen. But I think we have traditionally been accustomed to framing the conversation about medical intervention in terms of the benefits and less so in terms of the potential for things to go wrong.
There needs to be a paradigm shift, and the health care system needs to be part of this. Patients who are highly vigilant and who cultivate a healthy level of skepticism need to be viewed as informed, alert partners, not as hyperanxious and mistrustful. I think many organizations and individual clinicians struggle with this; they don’t quite trust what we’ll do with the knowledge that health care can be very unsafe.
The other piece of this equation is that the system has to take responsibility for making care safer, period. There are times when no amount of self-advocacy or patient empowerment can make up for sloppy processes or lapses in clinical judgment. If this is going to be participatory, the participation needs to flow both ways.
Kathleen, I’m so happy to see you helping with our blog here.
For those who don’t know, Kathleen is managing editor of our Journal of Participatory Medicine. We’re working to align this blog and the Journal – you’ll be seeing format changes that reflect their sibling status, and perhaps some coordinated interweaving of content themes. We’ll see.
In any case, if you’d like to submit a guest post, see our guest post guidelines, and if you’d like to submit to JoPM, see its author guidelines.