Many years ago, in 2000, the National Institute of Medicine performed a study evaluating the frequency and nature of errors in patient care. The results were astounding: an estimated 98,000 patients died annually as a result of preventable medical mistakes. Hundreds of thousands more were estimated to have suffered serious injuries from improper medical care. The rates of injury and death attributable to iatrogenic [physician caused] injuries and nosocomial [hospital-related] injuries, when compared to other leading causes of death such as heart attacks, cancer, accidents and the like, reflected that medical malpractice was an epidemic. A great hue and cry arose, and well-meaning programs and initiatives by the medical profession were instituted to attempt to stanch the metaphorical and literal blood-letting.
Unfortunately, a new study indicates that not only hasn’t the problem been addressed and eliminated, it may well be worse – far worse – than first estimated. A study in the September 2013 Journal of Patient Safety concluded that patient deaths associated with preventable harm to patients was estimated atmore than 400,000 persons per year! That places medical errors as the third leading cause of death in the United States. And as it that isn’t alarming enough, serious injuries to patients were estimate to occur 10-20 fold times more than lethal mistakes. In other words, as many as 4,000,000 – 8,000,000 patients suffer a serious injury due to medical mistakes. The authors of the study note that even those estimates may be low, because of the fact that medical professionals who are aware that mistakes have been made are often reluctant to document those mistakes in the medical records, meaning many medical mistakes cannot even by accounted for. (A physician survey found 2/3 of respondents indicating they were aware of a recent occasion when a medical mistake was not documented in the patient’s medical chart, or communicated to the patient or other caregivers.)
The study found that most mistakes can be categorized in five basic ways:
- Errors of commission
- Errors of omission
- Errors of diagnosis
- Errors of communication
- Contextual errors.
The most common kinds of errors are easiest to understand: Errors of omission and commission. These are simply failures to do that which a reasonable and prudent physician or nurse would do, or thedoing of some action that a reasonably careful doctor or nurse would not do. Administering a drug to the wrong patient, leaving a surgical sponge inside a patient, failing to perform a radiology test on a head injured patient are examples of errors of omission and commission.
Errors of communication often result in the complex bureaucracy of the hospital setting. Nurses fail to communicate significant changes in a patient condition, a physician fails to chart an intended Physician Order for a desired test, medication or treatment.
Diagnostic errors include those resulting from a failure to take a thorough medical history from a patient to find out about relevant medical problems in the past and appreciate their relevance to the problem the patient is currently suffering from. They can occur from failing to recognize all the possible medical conditions that might be causing a patient’s symptoms and formulate an appropriate “differential diagnosis” listing all the reasonable possibilities that should be considered, and ruled out. They can result from a failure to identify abnormalities on x-rays, and lab or other test results.
Examples of contextual errors can include failing to appreciate the inability of an elderly or mentally disabled patient to understand and follow basic medical advice with regard to returning for follow up testing, taking medication properly, and recognizing signs and symptoms of an urgent medical problem developing.
All in all, the study paints a continuing bleak picture of potential harm to patients, and a lack of accountability for such mistakes.
Contact Leeseberg Tuttle today if you need a Columbus Ohio medical malpractice lawyer. With a combined 75 years of experience in the Columbus, Ohio area, the attorneys at Leeseberg Tuttle are ready and willing to help you. Call us today at 614-221-2223 to schedule a free consultation and learn how we can properly protect your rights. For more information about our firm and about Ohio laws, visit us online at www.leesebergvalentine.com.
Journal of Patient Safety:
September 2013 – Volume 9 – Issue 3 – p 122-128
doi: 10.1097/PTS.0b013e3182948a69
Review Article Results: Using a weighted average of the 4 studies, a lower limit of 210,000 deaths per year was associated with preventable harm in hospitals. Given limitations in the search capability of the Global Trigger Tool and the incompleteness of medical records on which the Tool depends, the true number of premature deaths associated with preventable harm to patients was estimated at more than 400,000 per year. Serious harm seems to be 10- to 20-fold more common than lethal harm.
Conclusions: The epidemic of patient harm in hospitals must be taken more seriously if it is to be curtailed. Fully engaging patients and their advocates during hospital care, systematically seeking the patients’ voice in identifying harms, transparent accountability for harm, and intentional correction of root causes of harm will be necessary to accomplish this goal
* Errors of commission,
* Errors of omission,
* Errors of communication,
* Errors of context, and
* Diagnostic errors
A recent national survey showed that physicians often refuse to report a serious adverse event to anyone in authority.41 In the case of cardiologists, the highest nonreporting group of the specialties studied, nearly two-thirds of the respondents admitted that they had recently refused to report at least one serious medical error, of which they had first-hand knowledge, to anyone in authority. It is reasonable to suspect that clear evidence of such unreported medical errors often did not find their way into the medical records of the patients who were harmed.