May 19, 2009 -- Little progress has been made to reduce deadly medical errors in the U.S. in the past decade despite a call to action in 1999, according to a report by Consumers Union.
In 1999, the Institute of Medicine (IOM) issued an alarming report titled "To Err is Human," detailing the toll of preventable medical errors in the U.S; it estimated that up to 98,000 Americans die annually from them.
The report triggered a flurry of activity, including congressional hearings, introduction of legislative bills, and promises of reform. But today, more than 100,000 people a year still die from medical errors, says Lisa McGiffert, campaign director for the Safe Patient Project of Consumers Union and a report co-author. The estimate of 100,000 deaths is drawn from more recent data from the CDC.
"As a country we haven't moved forward as the Institute of Medicine has hoped," McGiffert tells WebMD. ''In 1999, the IOM said we should reduce errors by 50% over five years."
Even the 100,000 figure is an estimate, she says, because there is no centralized system for tracking and monitoring medical harm.
Measuring Progress Since 1999
In the new report, McGiffert and her colleagues looked at four key recommendations made by the IOM in 1999 to make health care safer. Here are the original recommendations, and the progress -- or lack thereof -- as assessed by Consumers Union, which publishes Consumer Reports:
Implement safe medication practices. To reduce the 1.5 million preventable medication errors annually, the IOM recommended stronger oversight by the FDA, such as looking at safety issues linked with similarly named drugs and with packaging and labeling as well as conducting post-market surveillance to detect risk in drugs already approved. But progress is lacking, the report says. While the FDA reviews new drug names for confusion, few are actually changed, it contends. And just 17% of hospitals use computerized physician-order-entry systems, according to a 2008 survey, even though the systems have been shown to reduce drug errors. No reliable system is available nationally to disclose medication errors by facility, the report says.
Create accountability through transparency. In the original report, the IOM recommended two national reporting systems for medical errors: one voluntary that would be confidential to help health care providers learn from mistakes and another mandatory that would make mistakes public. Progress has been made mainly with the voluntary system, says McGiffert. ''The public has not been given the information to know whether we are safer now than we were then," she says. She notes that 24 states don't have any medical error reporting systems in place; most that do don't publicize facility-specific information to the public.
Measure the problem. In the original report, the IOM called for a Center for Patient Safety to be set up within the federal Agency for Healthcare Research and Quality (AHRQ). But while the AHRQ is trying to do this, the efforts are hampered by the lack of reliable reporting of medical errors, according to the report. In its most recent report, issued this month, the AHRQ reported that patient safety declined by about 1% a year in the six years after the 1999 report.
Raise standards for competency in patient safety. The IOM called for periodic tests of doctors' and nurses' competence and knowledge of safety practices. Many such campaigns have been launched in the private sector, McGiffert says, but the results remain fragmented, with no process to measure improvement on a national basis.
"Certainly there has been a lot of work done," McGiffert tells WebMD. "But we don't know if it's done any good. We have no real evidence we are better off than we were 10 years ago. There is no disclosure of information. There is very little information to grab onto."
On a positive note: "We have worked for hospital disclosure of infection rates," she says. "Twenty six states now have laws requiring it, and eight have actually put out reports."
What's needed, she says, is a national system, run by an independent entity, to track progress on health care safety.
Medical Errors: "Failure"
The new report is "right on," says Lucian Leape, MD, adjunct professor of health policy at Harvard School of Public Health and longtime patient safety advocate. The lack of progress in implementing the IOM recommendations, he says, ''is an immense public policy failure."
"It's hard to argue with the fact that we're not where we need to be,'' agrees Diane Pinakiewicz, president of the National Patient Safety Foundation.
Even so, some progress is evident, Leape tells WebMD. "There have been improvements on the hospital level with very little help from the government," he says. He is referring to the common hospital protocols to be sure the right patient is operated on, the right side or limb is operated on, and it's the right operation.
"We have done more in America than any other country in the world to increase patient safety," he says. But it's been done at the ground level, by individual doctors, nurses and hospitals, he says.