Nov. 30, 1999 (Minneapolis) -- The news is in, and it's bad but not hopeless. There is an epidemic of medical errors, and the etiology is multifactorial: scrawled prescriptions, lookalike drug names, and an exploding knowledge base, according to a report from the Institute of Medicine (IOM).
The report, entitled "To err is human," cites two studies showing that between 44,000 and 98,000 hospitalized Americans die each year due to medical mistakes. As the title suggests, there is no way to eliminate errors, but the IOM says there are ways to prevent them, and save lives.
Medical errors are not due to individuals, but to poorly designed systems, says Linda Kohn, PhD, co-director for the IOM's Quality of Health Care in America Project, which issued the report. Therefore, the means for improving safety will be system-oriented, rather than involve the targeting of individuals.
"We need to redesign processes to make care safer," Kohn tells WebMD. For example, the report recommends a patient safety agency under the auspices of the Department of Health and Human Services. However, just because the necessary improvements transcend individual physicians doesn't mean that physicians should take the Project's findings lightly.
"This is a very serious issue. Patients are being harmed by errors in the health care system," she says. In the IOM's press release, medical errors were referred to as a "leading cause" of disability and death, killing more people annually than highway accidents, breast cancer, or AIDS. "We can make the system safer by designing safety into the system," Kohn tells WebMD.
"The [IOM] has been looking at the infrastructure of the health care delivery system for years. The notion of looking for medical errors is not new," says Rick Wade, senior vice president of the American Hospital Association. He tells WebMD that one reason for these recommendations coming after public concerns about medical malpractice has been a database lag. "There's a lack of uniformity among states in the reporting of errors," he says. "The systematic safeguards aren't sophisticated from a technologic standpoint, and manual checks are subject to human error."
Because the fear of litigation or other repercussions impedes an open discussion, the report calls for minor errors to be treated in confidence. "If errors cause no harm or little harm, the information about these errors should be protected [so that we can put] corrections into the system. On the other hand, serious errors need to be reported externally so we can learn," Kohn says. "The committee distinguished between these two types of errors.
"Health care organizations need to make patient safety a priority and devote resources to designing safer systems. Medical errors ... can occur in all issues related to the process of providing care. We know the system can be designed to improve safety, because several industries have better safety records," Kohn says.
Examples of systems errors include the classic, poor handwriting on paper prescriptions. If physicians in a health care system type prescriptions onto an electronic template, the risk of penmanship-related problems is eliminated. While individual physicians and pharmacists have little recourse other than being more careful about drugs with similar names, the FDA can monitor these names and call attention to the possibility of confusing them, Kohn tells WebMD.
Another example she cites is the rapid growth in medical knowledge, which makes keeping abreast difficult for health care workers. "Access to information, at the right place and at the right time, can help improve safety," she says.
Mainstream media analyses have been skeptical about organized medicine's concern about patient safety, which they view as belated. For example, in the New York Times, Lawrence K. Altman questions "why, after so many years of public attention to medical malpractice, the National Academy of Sciences wants to crack down now."
Systemically based errors can be reduced without making health care professionals even more vulnerable to lawsuits, and without reinventing the wheel, Wade tells WebMD. "[O]ur systems for preventing [errors] are not what the public would expect of us," he says. "We need a reporting mechanism that will [allow information to be used] for all the right reasons and not used for all the wrong reasons. ... We can improve our systems by finding the places where medical error prevention is being done well and translating that information across the system. This approach will help us develop a system of safeguards that improve patient safety."
The IOM report is the first in a series to be issued by the Quality of Health Care in America Project, says Kohn. In a statement issued by the National Patient Safety Foundation (NPSF), which was founded by the American Medical Association, Nancy W. Dickey, MD, calls for continued vigilance against errors, and says, "While we may never achieve perfection, we must strive for it." She is past president of the AMA and past chairwoman of NPSF's board of directors.
The IOM is a private, nonprofit institution.