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Medical Errors

10/18/2005
Source: 
Institute of Medicine (IOM)

The Institute of Medicine (IOM), reports that as many as 98,000 Americans die each year and another 1,000,000 are injured as a result of preventable medical errors that cost the nation an estimated $29 billion. In its comprehensive book titled "To Err Is Human," the IOM recounts two studies which reported on adverse events.

The Harvard Medical Practice Study reported on more than 30,000 randomly selected discharges from 51 randomly selected hospitals in New York in 1984. In 1992, a study of adverse events in Colorado and Utah reviewed a random sample of 15,000 discharges from a representative sample of hospitals in these two states.

In its study, the IOM reports that some estimate that the 98,000 annual number likely underestimates the occurrence of preventable errors because (i) it only considered hospital errors and not errors in other medical settings (ii) it only considered certain more serious injury cases and (iii) the study imposed a very high threshold to determine whether an error occurred.

In another study contained in the IOM's report, 45.8 % of 1,047 patients admitted to two intensive care units at a large teaching hospital were identified as being the victim of an inappropriate decision when an appropriate alternative could have been chosen.

In another published study of 182 deaths caused by three conditions (heart attack, pneumonia, and CVA or stroke), in 12 hospitals, it was found that at least 14% and possibly as many as 27% of the deaths might have been prevented. According to the IOM, a separate 1991 analysis of 203 incidents of cardiac arrest at a teaching hospital found that half of the 14% that experienced a complication could have been prevented.

Three years after the IOM published "To Err Is Human," the IOM reports that little has been done to reduce death or injury in this country. Shortly after the release of the report, Congress held hearings and set aside $50 million for research into the causes of preventable medical mistakes. The IOM reports that one reason for the lack of progress since the release of the report is fierce resistance by doctors and hospitals to bills requiring mandatory reporting.

Michael L. Millenson, a visiting scholar at Northwestern University and author of the 1997 book "Demanding Medical Excellence," observes that many doctors refute the report's central thesis that mistakes are numerous and affect all players in the increasingly dysfunctional health care system. And most resist the notion that hospitals' faulty systems need to be overhauled to guard against errors that can result from anything short of perfect performance by individuals.

"You won't believe the number of times I've heard a doctor say, with a straight face, 'I don't make mistakes,'" said Millenson. "There's an old saying in aviation: The pilot is the first one at the scene of an accident. Well, in medicine, if someone makes a mistake, who gets hurt? It's not the doctor. Who pays? It's not the Hospital. Nobody's doing this on purpose, but they're not losing money on it, either."

The IOM reports that because only a minority of states require that serious errors be reported, it's impossible for experts to figure out how to prevent them in the future. IOM panelist Arthur Levin states: "We can't even count the errors, so we don't have any more real information than we had when we wrote the report."