Medical Errors and the United States Healthcare System _ ___________________________________________
• An estimated 29% of Medicare patients in rehabilitation hospital stays experienced an adverse event and half of these were considered preventable, which is similar to findings regarding adverse events in hospitals and skilled nursing facilities (27% and 33%, respectively [7]. • An assessment of the frequency and types of errors identified by patients who read open ambulatory visit notes found 20% of patients who read a note reported finding a mistake and 40% perceived the mistake as serious. Among patient-reported very serious errors, the most common characterizations were mistakes in diagnoses, medical history, medications, physical examination, test results, notes on the wrong patient, and left vs right side [8].
INTRODUCTION Medical errors are an under-recognized cause of death in the United States. Error rates are significantly higher in the United States compared with other developed countries such as Canada, Australia, New Zealand, Germany, and the United Kingdom [1]. Patient safety experts at Johns Hopkins analyzed medical death rates over an 8-year period and estimated that >250,000 deaths each year are due to medical error in the United States (Figure 1) [2]. Medical Errors _V2 March 31, 2020
FIGURE 1. DEATH IN THE UNITED STATES
MEDICAL ERROR OR UNINTENDED CONSEQUENCE?
4 The trend is for patient safety experts to focus on improving the safety of healthcare systems to reduce the probability of errors and mitigate their effects rather than focus on an indi- vidual’s actions. Medical errors represent an opportunity for constructive changes and improved education in healthcare delivery [11]. The term medical error captures all the unintended events that occur during a patient’s care cycle. These can be as innocent as the wrong doctor’s name placed into a chart, or a missed dose of medication that has no consequences to the patient. Some medical errors are discovered before any harm occurs, and some are so benign they go completely unnoticed [9]. Some clinicians believe that the term medical error is exces- sively negative, antagonistic, and perpetuates a culture of blame. Many experts suggest the term medical error should not be used at all, because, for example, an adverse medication event could be an unintended consequence of a therapeutic intervention. However, adverse patient outcomes may occur because of medical errors and to delete the term obscures the goal of preventing and managing its causes and effects [10]. Regardless of the nomenclature, medical errors typically occur from the convergence of multiple contributing factors. Public and legislative intolerance for medical errors typically illustrates a lack of understanding that some errors may not be prevent- able with current technology or the resources available to the practitioner [11].
Source: National Center for Health Statistics, BMJ
Figure 1
Medical errors increase personal and institutional financial burdens, adding an estimated $20 billion to US healthcare costs annually. 3 Beyond the emotional toll on the patient, medical errors have substantial negative effects on the mental and emotional well-being of the providers who are involved. 4 These negative effects include guilt, shame, anxiety, fear, depression, posttraumatic stress disorder and suicidality. 4 This statistic makes medical errors the third highest cause of death in the United States, accounting for 10% of all deaths [2]. Unfortunately, the way that the Centers for Disease Con- trol and Prevention collects national health statistics fails to classify medical errors separately on death certificates. Because medical errors are not listed, they do not get the public atten- tion given to other leading causes of death such as cancer and heart disease [2]. Although improvement has occurred in specific areas, significant challenges remain. For example: • One in two surgeries involved a medication error and/or an adverse drug event. 5 • Approximately 5% of all adult Americans experience a diagnostic error in outpatient settings every year. 6 • An estimated 29% of Medicare patients in rehabilitation hospital stays experienced an adverse event and half of these were considered preventable,
Medical errors increase personal and institutional financial burdens, adding an estimated $20 billion to US healthcare costs annually [3]. Beyond the emotional toll on the patient, medical errors have substantial negative effects on the mental and emotional well-being of the providers who are involved [4]. These negative effects include guilt, shame, anxiety, fear, depression, posttraumatic stress disorder and suicidality [4]. Although improvement has occurred in specific areas, signifi- cant challenges remain. For example: • One in two surgeries involved a medication error and/or an adverse drug event [5]. • Approximately 5% of all adult Americans experience a diagnostic error in outpatient settings every year [6].
28
MDFL0627
Powered by FlippingBook