On July 17th, 2014 the Senate Subcommittee on Primary Health and Aging held an important hearing on “Over 1000 Deaths Per Day is Too Many: The Need to Improve Patient Safety“. Six experts testified and shared pdf. files of their reports including citations.
To download all of the experts’ complete testimonies or listen to the hearing go here.
To get links to all expert excerpts published in Confident Voices in Healthcare Blog go here.
When it comes to tracking medical errors, we don’t really know how many hospital patients are harmed because there is no national effort to collect this information or to make it public. But three landmark studies in 2010 and 2011 gave us some solid estimates of how often these errors and infections happen. The studies rocked the confidence of experts in the field who assumed piecemeal efforts to prevent medical harm were having an overall effect on improving patient safety. All of these studies looked at all harm – from minor to major – and included both errors and infections. All emphasized the need for the system to focus on a broader array of adverse events than the National Quality Forum list of serious adverse events. All used techniques that avoided the underreporting problems common to hospital self-reporting and misleading billing data.
US Health and Human Services Office of Inspector General (OIG) based its study on Medicare data and found that 27% of Medicare patients hospitalized in October 2008 were harmed from medical care. One in seven of them endured long-term and serious harm from hospital care (defined as events resulting in prolonged hospitalization, permanent disability, life-sustaining intervention, or death).7 The OIG estimated that 44 percent of the harm identified was preventable.
New England Journal of Medicine (NEJM) study revealed similar findings – one in four hospital patients are harmed.8 This study was done in North Carolina where there had been a high level of engagement in efforts to improve patient safety during the six years covered by the study. Despite this work, the surprising findings showed little evidence that harm had decreased substantially over that 6-year period. At the time, no public reporting of infections or errors was required of North Carolina hospitals. Without information about medical harm, the public cannot hold these hospitals accountable for their errors. The NEJM study found that 63% of these events were preventable and made the important point that “preventability” changes over time as new ways to keep patients safe are tried and measured.
Health Affairs study using the Institute for Healthcare Improvement’s global trigger tool9 found that one in three hospital patients are harmed.10 The study compared three methods for detecting adverse events in patients hospitalized in three large tertiary care centers, all teaching hospitals with well established patient safety programs, and found the most common methods used to track patient safety in the U.S. – self reporting and pulling information from administrative billing documents – missed 90% of adverse events.
A 2013 study, “A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care,” translated existing research into a reliable estimate of how many patients die from medical errors each year. Based largely on the findings cited above, the study estimated that the premature deaths of more than 400,000 patients each year was associated with preventable medical errors.11 When undetected diagnostic errors were added to that number, the study estimated up to 440,000 patients are harmed each year. These new estimates established medical harm as the third leading cause of death in the US.
(7) Department of Health and Human Services, Office of Inspector General, “Adverse Events in Hospitals: National Incidence Among Medicare Beneficiaries,” Daniel R. Levinson Inspector General, November 2010, OEI-06-09-00090.
(8) Christopher P. Landrigan, M.D., M.P.H., Gareth J. Parry, Ph.D., Catherine B. Bones, M.S.W., Andrew D. Hackbarth, M.Phil., Donald A. Goldmann, M.D., and Paul J. Sharek, M.D., M.P.H. , “Temporal Trends in Rates of Patient Harm
Resulting from Medical Care” The New England Journal of Medicine, November 25, 2010; 363;22.
(10) David C. Classen, Roger Resar, Frances Griffin, Frank Federico, Terri Frankel, Nancy Kimmel, John C. Whittington, Allan Frankel, Andrew Seger, and Brent C. James; “‘Global Trigger Tool’ Shows That Adverse Events In Hospitals May Be Ten Times Greater Than Previously Measured,”Health Affairs, April 2011, 30:4
(11) James, JT, “A new, evidence-based estimate of patient harms associated with hospital care.” Journal of Patient Safety, 2013 Sep;9(3):122-8. doi:10.1097/PTS.0b013e3182948a69.
To read my open letter to the Senate Subcommittee in response to the hearing go here.