Hospital Errors other than Surgery

Common Hospital Errors
Hospital Error Study Highlights
Insurance and Medicare Stop Paying for Errors
Steps you can take to prevent Hospital Errors

An average of 195,000 Americans died annually in 2000, 2001 and 2002 because of potentially preventable, in-hospital medical errors, according to a study of 37 million patient records conducted by HealthGrades, a healthcare quality company.

The number of deaths was nearly double that found in the 1999 Institute of Medicine (IOM) study To Err is Human, with an associated cost of more than $6 billion per year. At the time the study was issued, the IOM said the rate of in-hospital deaths should be considered a national epidemic.

The study was published in the Journal of the American Medical Association (JAMA) in October of 2003, and included 7.5 million patient records from 28 states over one year.  HealthGrades looked at three years of Medicare data in all 50 states and D.C. (Medicare population represented approximately 45 percent of all hospital admissions–excluding obstetric patients).

The HealthGrades study shows that the IOM report may have underestimated the number of deaths due to medical errors, and, moreover, that there is little evidence that patient safety has improved in the last five years.  That is the equivalent of 390 jumbo jets full of people are dying each year due to likely preventable, in-hospital medical errors, making this one of the leading killers in the U.S.

Common Hospital Errors

• Doctor’s orders not legible, unclear, or wrong
• Confusion of one patient with another
• Diagnostic errors
• Medication errors
• Hospital infections including MRSA (methicillin-resistant Staphylococcus aureus) – a type of staph infection that’s resistant to many antibiotics
• DVT—or deep vein thrombosis—a blood clot, typically deep in the veins of the leg. If the clot breaks free and travels through the bloodstream, it can get lodged in the arteries of the lungs, cutting off the blood’s supply of oxygen
• Uncontrolled bleeding after surgery
• Anesthesia complications

Hospital Error Study Highlights

• About 1.14 million patient-safety incidents occurred among the 37 million hospitalizations in the Medicare population over the years 2000-2002.
• Of the total 323,993 deaths among Medicare patients in those years that were caused by one or more hospital errors, 263,864, or 81 percent, of these deaths were directly attributable to the error(s).
• One in every four Medicare patients who were hospitalized from 2000 to 2002 and experienced a patient-error died.
• Hospital errors with the highest rates per 1,000 hospitalizations were failure to rescue, decubitus ulcer and postoperative sepsis, which accounted for almost 60 percent of all patient-safety incidents that occurred.

Overall, the best performing hospitals (hospitals that had the lowest overall patient safety incident rates of all hospitals studied, defined as the top 7.5 percent of all hospitals studied) had five fewer deaths per 1000 hospitalizations compared to the bottom 10th percentile of hospitals. This significant mortality difference is attributable to fewer hospital errors at the best performing hospitals.

Insurance and Medicare Stop Paying for Errors

This has led some payers—including Medicare—to ask “Why should we be picking up the tab for the hospitals’ mistakes?”  Answering that question, the Centers for Medicare and Medicaid Services (CMS) is threatening to stop paying hospitals for costs incurred as a result of some of the most common and preventable medical errors-a list that CMS labels:

• Patient death or serious disability associated with a medication error (e.g., error involving the wrong drug, wrong dose, wrong patient, wrong time, wrong rate, wrong preparation or wrong route of administration)
• Patient death or serious disability associated with a hemolytic reaction due to the administration of ABO-incompatible blood or blood products
• Maternal death or serious disability associated with labor or delivery on a low-risk pregnancy while being cared for in a healthcare facility
• Patient death or serious disability associated with hypoglycemia, the onset of which occurs while the patient is being cared for in a healthcare facility
• Death or serious disability (kernicterus) associated with failure to identify and treat hyperbilirubinemia in neonates
• Stage 3 or 4 pressure ulcers acquired after admission to a healthcare facility
• Patient death or serious disability due to spinal manipulative therapy

Steps you can take to prevent Hospital Errors:

From Agency for Healthcare Research and Quality:

1. Speak up if you have questions or concerns.

You have a right to question anyone who is involved with your care.

2.   Make sure that someone, such as your personal doctor, is in charge of your care.

This is especially important if you have many health problems or are in a hospital.

3.   Make sure that all health professionals involved in your care have important health information about you.

Do not assume that everyone knows everything they need to.

4.   Ask a family member or friend to be there with you and to be your advocate (someone who can help get things done and speak up for you if you can’t).

Even if you think you don’t need help now, you might need it later.

5.   Know that “more” is not always better.

It is a good idea to find out why a test or treatment is needed and how it can help you. You could be better off without it.

6.   If you have a test, don’t assume that no news is good news.

Ask about the results.  And get a copy of them-especially MRI, x-rays or CT scans.

7.   Learn about your condition and treatments by asking your doctor and nurse and by using other reliable sources.

For example, treatment recommendations based on the latest scientific evidence are available from the National Guidelines Clearinghouse at http://www.guideline.gov. Ask your doctor if your treatment is based on the latest evidence.