Epidemic of Medical Injuries Confirmed

32,600 Annual Medical-Error Deaths Just 'Tip of Iceberg'

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Oct. 10, 2003 -- Just 18 types of medical injuries every year kill 32,600 U.S. hospital patients -- and that's "only the tip of the iceberg," a new study shows.

Medical injuries come from medical errors. A 1999 Institute of Medicine report showed that there's an ongoing epidemic of medical errors. It's still going on, report Chunliu Zhan, MD, PhD, and Marlene R. Miller, MD, in the Oct. 8 issue of TheJournal of the American Medical Association.

"Our results clearly show that medical injuries in hospitals pose a significant threat to patients and incur substantial costs to society," Zhan and Miller conclude. Zhan is a researcher at the U.S. Agency for Healthcare Research and Quality in Rockville, Md., which funded the study. Miller is a researcher at Johns Hopkins University in Baltimore.

What's a medical injury? It's when treatment for one problem causes another problem. A foreign object left in a person's body during surgery is one example. Reopening of surgical wounds is another.

Most experts agree that the main problem isn't bungling doctors. Instead, most medical injuries result from complex hospital care systems that break down -- sometimes with catastrophic results. Patients pay in extra hospital days, suffering, and death. Society pays in vastly increased health-care costs -- $9.3 billion at the iceberg's tip.

If terrorists cost America this much in lives and dollars, it would be a national emergency. But it's not even possible to know the true extent of the medical-injury problem. One reason: Only 20 states require hospitals to report serious medical injuries. And that information is kept out of sight. Another reason is the lack of a standard system for defining injury.

"No published study has ever used these data, most likely because they are strictly guarded from the public and researchers," Zhan and Miller note.

To get a handle on the problem, the researchers looked at computerized administrative data from the 28 states that voluntarily offered it. Administrative data are collected and used for reimbursement purposes. This allowed the researchers to look for patterns likely to reveal medical injuries. Only 20 types of medical injury can reliably be found this way.

Zhan and Miller looked at 18 of them. But they note that this method greatly underestimates the problem. The 1999 IOM study, for example, concluded that medical injuries result in up to 98,000 deaths and $17 billion in direct health-care costs.

In an editorial accompanying the study, Harvard and Beth Israel General Hospital researchers Saul N. Weingart, MD, PhD, and Lisa I. Iezzoni, MD, note that human errors always will happen. The focus should be on preventable errors, they write.

"Unfortunately, preventable injuries are technically difficult and expensive to capture," they note. Doctors "rarely" report incidents, so the real error rate likely is more than 10 times the number gleaned from mandatory reporting systems.

Weingart and Iezzoni are hopeful that the ongoing computerization of medical records will make it easier to detect medical errors and find out how to prevent them. Meanwhile, they praise Zhan and Miller for taking a step in the right direction.

"Developing and validating a robust set of measurement tools is essential to move patient safety information out of the shadows and into the light," they conclude.

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SOURCES: Zhan, C. and Miller, M. The Journal of the American Medical Association, Oct. 8, 2003; vol 290: pp 1868-1874. Weingart, S. and Iezzoni, L. TheJournal of the American Medical Association, Oct. 8, 2003; vol 290: pp 1917-1919.
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