Study: No Improvement in Hospital Safety

Researchers See Little Change in Medical Errors Over the Last Decade

Medically Reviewed by Laura J. Martin, MD on November 24, 2010
From the WebMD Archives

Nov. 24, 2010 -- Some hospitals are no safer today than they were 10 years ago, according to a study published in the New England Journal of Medicine.

In 1999, an Institute of Medicine (IOM) report revealed that medical errors cause as many as 98,000 deaths and more than 1 million injuries per year. Researchers have found that despite efforts to ensure patient safety in the years since the report was published, those rates have remained largely unchanged.

“We were disappointed but not very surprised [by the results],” study researcher Christopher Paul Landrigan, MD, MPH, an assistant professor at Harvard Medical School, says.

The researchers looked at 10 randomly selected hospitals in North Carolina, a state that, according to the study, has been highly engaged in efforts to improve patient safety in the aftermath of the IOM report.

“Since North Carolina has been a leader in efforts to improve safety,” the researchers write, “a lack of improvement in this state suggests that further improvement is also needed at the national level.”

In conducting the study, researchers reviewed 2,341 hospital admissions from 2002 to 2007. A quarter of that number suffered some sort of medical error while receiving medical care.

While most of the errors caused temporary complications, such as urinary tract infections, hypoglycemia, and pressure ulcers, nearly 10% were life threatening. Fourteen patients died; more than half of those deaths -- and the majority of other problems -- were preventable, according to the study.

What Needs to Change

Landrigan says that although efforts to improve patient safety have “ramped up considerably” in the past few years, success is stymied by several factors. Not least among them is the difficulty of changing long-established work practices common in hospitals, practices that he said are known to be detrimental to patient safety.

Landrigan points to the need for a reduction in the number of hours that medical residents are permitted to work in a single shift, as well as the implementation of surgical checklists and strategies proven to prevent infection. According to the study, something as basic to patient safety as hand washing continues to be a problem.

Another challenge is the lack of electronic record keeping. Less than 10% of hospitals nationwide have basic computerized records in place, the study notes, even though some studies show that increasing the use of electronic records improves patient outcomes.

“We know it works,” Landrigan says. But, he added, “these types of changes are a challenge; the health care industry has deeply established history and traditions.”

Also needed, he says, is a nationwide system for reporting harm due to medical errors. Such a system would enable researchers such as Landrigan to better track what helps -- and what harms -- patients. He would also like to see hospitals coordinate with one another when devising and implementing patient safety strategies.

“We are just at the beginning of improving patient safety,” Landrigan says. “I’m very hopeful that things will get better.”

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Christopher Paul Landrigan, MD, MPH, assistant professor of pediatrics and medicine, Harvard Medical School.

Landrigan, C. New England Journal of Medicine, Nov. 25, 2010; vol 363: pp 2124-2134.

Kohn, L. et al. To err is human: building a safer health system.  Washington, D.C. National Academies Press, 1999.

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