Tuesday, December 14, 2010
Hospitals are Unsafe - There Are Still Plenty of Preventable Medical Errors
The results of a recently published study are therefore concerning. A group lead by Dr Landrigan at Harvard evaluated the number of “harms” which occurred at ten randomly selected North Carolina hospitals. They taught a cadre of reviewers to use “triggers” in the medical record to prompt further analysis for an error that caused harm. The harms were categorized into five groups with E being temporary yet requiring an intervention through, F temporary but requiring initial or prolonged hospitalization, G permanent harm, H as life threatening harm and I causing or contributing to death. They then selected 10 records per quarter for the years 2002 through 2007 from each hospital, at random. The records were then reviewed in a random order by multiple internal and external trained reviewers, both nurses and doctors.
They found 588 harms among the 10,415 patient days or 57 harms/1000 days or 25 harms per 100 admissions. About 63% or 364 of the 588 harms were classified as preventable! These included 13 that caused permanent injury, 35 being life threatening and 9 contributing or leading to death.
Similar to prior studies, the harms occurred most frequently after procedures and medications. Most harms fell into categories E (144) and F (163).
It was disappointing to find that the rates of adverse events did not decline over the study time period. This, despite the fact that in North Carolina has an enviable record of a high level of engagement in patient safety programs and studies.
So there are still plenty of adverse events that occur in a hospital, they are most likely to be related to procedures or medications, most are preventable, and all too many are life threatening or lead to death.
This leads to the question of whether the many and various approaches that hospitals have embarked upon are actually doing what they need to do. It may be time for a reappraisal. Certainly a patient should have the expectation of not being harmed when in the hospital.
Praise for Dr Schimpff
The craft of science writing requires skills that are arguably the most underestimated and misunderstood in the media world. Dumbing down all too often gets mistaken for clarity. Showmanship frequently masks a poor presentation of scientific issues. Factoids are paraded in lieu of ideas. Answers are marketed at the expense of searching questions. By contrast, Steve Schimpff provides a fine combination of enlightenment and reading satisfaction. As a medical scientist he brings his readers encyclopedic knowledge of his subject. As a teacher and as a medical ambassador to other disciplines he's learned how to explain medical breakthroughs without unnecessary jargon. As an advisor to policymakers he's acquired the knack of cutting directly to the practical effects, showing how advances in medical science affect the big lifestyle and economic questions that concern us all. But Schimpff's greatest strength as a writer is that he's a physician through and through, caring above all for the person. His engaging conversational style, insights and fascinating treasury of cutting-edge information leave both lay readers and medical professionals turning his pages. In his hands the impact of new medical technologies and discoveries becomes an engrossing story about what lies ahead for us in the 21st century: as healthy people, as patients of all ages, as children, as parents, as taxpayers, as both consumers and providers of health services. There can be few greater stories than the adventure of what awaits our minds, bodies, budgets, lifespans and societies as new technologies change our world. Schimpff tells it with passion, vision, sweep, intelligence and an urgency that none of us can ignore.
-- N.J. Slabbert, science writer, co-author of Innovation, The Key to Prosperity: Technology & America's Role in the 21st Century Global Economy (with Aris Melissaratos, director of technology enterprise at the John Hopkins University).