July 27, 2004 -- Despite widely publicized reports of medical errors, a new report shows patient safety still suffers at American hospitals.
Nearly 195,000 people in the U.S. died each year as a result of potentially avoidable medical errors in 2000, 2001, and 2002, according to a new study of 37 million patient records released today.
"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.," says Samantha Collier, MD, in a news release. Collier is vice president of medical affairs at Health Grades Inc., which conducted the study.
"If the Center for Disease Control's annual list of leading causes of death included medical errors, it would show up as number six, ahead of diabetes, pneumonia, Alzheimer's disease and renal disease," says Collier. "Hospitals need to act on this, and consumers need to arm themselves with enough information to make quality-oriented health care choices when selecting a hospital."
Researchers say it's the first study to look at the potentially avoidable deaths and excess costs associated with medical errors across U.S. hospitals among those most at risk: Medicare patients, which represent about 45% of all short-term hospital admissions.
Extrapolating their findings to the nation as a whole (and excluding deaths and incidences during labor and delivery), researchers estimate that more than 575,000 preventable deaths occurred as a result of the 2.5 million patient safety incidents that occurred at U.S. hospitals from 2000 to 2002. These medical errors also resulted in an additional $19 billion in health-care costs.
The report shows that rates of medical errors vary only a small amount across different hospitals and regions. However, hospitals in the Central and Western regions of the U.S. performed better than the national average and better than those in the Northeast and Sunbelt. Teaching hospitals and larger hospitals with more than 200 beds fared slightly worse than non-teaching hospitals for most types of medical errors.
Measuring Medical Errors
Researchers say the results of this report suggest there is little evidence that patient safety has improved since the Institute of Medicine released its landmark report on medical errors in 1999.
The IOM's report found that nearly 100,000 people die each year as a result of medical errors and defined patient safety as "freedom from accidental injury due to medical care or medical errors."
Following the release of the IOM report, the Agency for Healthcare Research and Quality (AHRQ) developed a set of patient safety indicators designed to screen hospital administrative data for areas of concern.
These indicators include conditions caused by medical errors or improper care, such as bed sores, leaving a foreign object in the body during procedures, infection and other complications following surgery, and failure to diagnose and treat a patient in time.
Medical Errors Hamper Hospitals
In the study, researchers looked at rates of 16 common patient safety incidents among Medicare patients treated in every hospital in the U.S. from 2000 to 2002 and assessed the impact of these events on death and medical costs.
It found more than a million patient safety incidents caused by medical errors occurred from 2000 through 2002 among the 37 million Medicare hospitalizations studied, which resulted in more than $8.5 billion in additional medical costs over three years.
Of the nearly 324,000 deaths that occurred among Medicare patients who experienced a patient safety incident, researchers say more than 80% of these deaths were preventable and attributable to the patient safety incident.
Three types of medical errors accounted for almost 60% of patient safety incidents:
- Failure to diagnose and treat in time: 155 incidents per 1,000 at-risk hospitalizations
- Bed sores (skin and deeper tissue ulcers that form as a result of constant pressure on a particular site of the body): 30 cases per 1,000 at-risk hospitalizations
- Infection following surgery: 13 incidents per 1,000 at-risk hospitalizations
Failure to diagnose and treat in time and unexpected death in a low-risk patient accounted for nearly 75% of all deaths attributable to patient safety incidents.
As shown by previous studies, researchers found that Medicare patients had a higher rate of patient safety incidents than other patient groups.
The study also showed that medical errors were more common among patients who had been admitted to a hospital for a medical condition rather than a surgical reason. Among those who suffered from medical errors, heart failure and pneumonia were the two top reasons for admission.
Recommendations for Reducing Medical Errors
Researchers say the number of medical errors found by this study may represent only the tip of the iceberg. They say the volume of medical errors found in this report is lower than those reported by others, which they say is most likely because they analyzed only selected types of incidents that occurred during hospitalization of Medicare patients.
Researchers recommend that until effective strategies are developed to reduce medical errors overall, focused improvement efforts in four key areas could yield substantial benefits.
"If we could focus our efforts on just four key areas -- failure to rescue, bed sores, postoperative [infection] and postoperative pulmonary embolism [a blood clot in the lung] -- and reduce those incidents by just 20%, we could prevent save 39,000 people from dying every year," says Collier.
In addition to releasing its findings on patient safety, Health Grades also released its first annual Distinguished Hospital Award for Patient Safety. The awards were given to 88 hospitals in 23 states for having the nation's lowest rates of medical errors and patient safety incidents. For a list of winners, see www.healthgrades.com.