Medical
Errors
The Institute of Medicine (IOM), reports
that as many as 98,000 Americans die each year and
another 1,000,000 are injured as a result of preventable
medical errors that cost the nation an estimated $29
billion. In its comprehensive book titled "To
Err Is Human," the IOM recounts two studies which
reported on adverse events.
The Harvard Medical Practice Study reported
on more than 30,000 randomly selected discharges from
51 randomly selected hospitals in New York in 1984.
In 1992, a study of adverse events in Colorado and
Utah reviewed a random sample of 15,000 discharges
from a representative sample of hospitals in these
two states.
In its study, the IOM reports that some
estimate that the 98,000 annual number likely underestimates
the occurrence of preventable errors because (i) it
only considered hospital errors and not errors in
other medical settings (ii) it only considered certain
more serious injury cases and (iii) the study imposed
a very high threshold to determine whether an error
occurred.
In another study contained in the IOM's
report, 45.8 % of 1,047 patients admitted to two intensive
care units at a large teaching hospital were identified
as being the victim of an inappropriate decision when
an appropriate alternative could have been chosen.
In another published study of 182 deaths
caused by three conditions (heart attack, pneumonia,
and CVA or stroke), in 12 hospitals, it was found
that at least 14% and possibly as many as 27% of the
deaths might have been prevented. According to the
IOM, a separate 1991 analysis of 203 incidents of
cardiac arrest at a teaching hospital found that half
of the 14% that experienced a complication could have
been prevented.
Three years after the IOM published
"To Err Is Human," the IOM reports that
little has been done to reduce death or injury in
this country. Shortly after the release of the report,
Congress held hearings and set aside $50 million for
research into the causes of preventable medical mistakes.
The IOM reports that one reason for the lack of progress
since the release of the report is fierce resistance
by doctors and hospitals to bills requiring mandatory
reporting.
Michael L. Millenson, a visiting scholar
at Northwestern University and author of the 1997
book "Demanding Medical Excellence," observes
that many doctors refute the report's central thesis
that mistakes are numerous and affect all players
in the increasingly dysfunctional health care system.
And most resist the notion that hospitals' faulty
systems need to be overhauled to guard against errors
that can result from anything short of perfect performance
by individuals.
"You won't believe the number of
times I've heard a doctor say, with a straight face,
'I don't make mistakes,'" said Millenson. "There's
an old saying in aviation: The pilot is the first
one at the scene of an accident. Well, in medicine,
if someone makes a mistake, who gets hurt? It's not
the doctor. Who pays? It's not the Hospital. Nobody's
doing this on purpose, but they're not losing money
on it, either."
The IOM reports that because only a
minority of states require that serious errors be
reported, it's impossible for experts to figure out
how to prevent them in the future. IOM panelist Arthur
Levin states: "We can't even count the errors,
so we don't have any more real information than we
had when we wrote the report."
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