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In the United States medical error is estimated to result in 44,000 to 98,000 unnecessary deaths and 1,000,000 excess injuries each year. It is estimated that in a typical 100 to 300 bed hospital in the United States, excess costs of $1,000,000 to $3,000,000 attributable to prolonged stays and complications just due to medication errors occur yearly.
Medical care is frequently compared adversely to aviation, in that, while many of the factors which lead to error are similar, aviation's error management protocols are much more effective.
Epidemiology of medical error
Medical errors are associated with inexperienced clinicians, new procedures, extremes of age, complex care and urgent care.
Approaches to error
Traditionally, errors are attributed to mistakes made by individuals who may be penalized for these mistakes. The usual approach to correct the errors is to create new rules with additional checking steps in the system, aiming to prevent further errors. As an example, an error of free flow IV administration of heparin is approached by teaching staff how to use the IV systems and to use special care in setting the IV pump. While overall errors become less likely, the checks add to workload and may in themselves be a cause of additional errors.
A newer model for improvement in medical care takes its origin from the work of W. Edwards Deming in a model of Total Quality Management. In this model, systems of care are evaluated for process issues that may contribute to errors in care. As an example, in such a system the error of free flow IV administration of Heparin is dealt with by not using IV heparin and substituting subcutaneous administration of heparin, obviating the entire problem. However, such an approach presupposes available research showing that subcutaneous heparin is as effective as IV. Thus, most systems use a combination of approaches to the problem.
The field of medicine that has taken the lead in systems approaches to safety is Anaesthesiology. Steps such as standardization of IV medications to 1 ml doses, national and international color coding standards, and development of improved airway support devices has made anesthesia care a model of systems improvement in care.
A 2005 study by Wendy Levinson of the University of Toronto showed surgeons discussing medical errors used the word "error" or "mistake" in only 57 per cent of disclosure conversations and offered a verbal apology only 47 per cent of the time.
Examples of errors
- Misdiagnosis
- Giving the wrong drug or (wrong patient, wrong chemical, wrong dose, wrong time, wrong route)
- Giving two or more drugs that interact unfavorably or cause poisonous metabolic byproducts
- Wrong site surgery such as amputating the wrong limb
Methods to improve safety and reduce error
- patient's informed consent policy
- patient's getting a second opinion from another independent practitioner with similar qualifications
- voluntary reporting of errors (to obtain valid data for cause analysis)
- root cause analysis
- systems for ensuring review by experienced or specialist practitioners
External links
- Institute of Medicine's Healthcare Quality Initiative
- Leapfrog Group on Patient Safety
- Institute for Healthcare Improvement
- AHRQ Patient Safety Network
- National Patient Safety Foundation
- Health Care Disclosure Project Project to improve quality through public reporting of physician and hospital performance.
- Hospital Compare A tool consumers can use to compare how well U.S. hospitals care for adult patients.
- Joint Commission Resources An organization dedicated to improving patient safety and quality of care.
- Joint Commission on Accreditation of Healthcare Organizations A private, not-for-profit organization and the nation's leader in continuously improving patient safety and health care quality.
- Wu AW. Medical error: the second victim. BMJ 2000; 320: 726-727
- Reason J. Human error: models and management. BMJ 2000; 320: 768-770
- "Why Doctors So Often Get It Wrong" by David Leonhardt, New York Times, Feb. 22, 2006
- Y. Bar-Yam, Making Things Work NECSI/Knowledge Press, 2005
- PRWEB on Medical Error
- Amalberti R, Auroy Y, Berwick D, et al. Five system barriers to achieve ultra safe health care. Ann Intern Med 2005;142:756-64
References
See also
"Medical error"