Medical Errors

V. Key Issues: Population Health >> H. Quality/Satisfaction >> Medical Errors (last update: 8.16.16)

Background

Prevalence

  • Medicare Patients. A 2010 report on medical errors by the Department of Health and Human Services (HHS), Office of Inspector General, found that 1 in 7 inpatients (14.3%) on Medicare suffered an adverse event, with 1 in 4 (25%) suffering some form of harm; this includes 1.6 million adverse events annually, which contributed to approximately 180 ,000 deaths (11.3%) that year. Office of the Inspector General. Adverse Events in Hospitals: National Incidence Among Medicare Beneficiaries. Washington, DC: Department of Health and Human Services; 2010. DHHS publication OEI-06-09-00090.
  • North Carolina Patients. A review of admissions in 10 North Carolina hospitals found that 18.1% of patients were harmed during hospital stays, with more than 63% of these injuries preventable; 2.4% of errors resulted in death, and 2.9% in permanent injury.

Deaths Due to Medical Errors

  • All Patients. A 2013 literature synthesis concluded “the number of premature deaths associated with preventable harm to patients was estimated at more than 400,000 per year.”
  • Hospital Patients.
    • 1999. A 1999 Institute of Medicine report, To Err is Human, concluded that 44,000 to 98,000 people were dying in United States hospitals each year as a result of preventable medical errors.
    • 2010. A 2010 study in the New England Journal of Medicine followed 10 North Carolina hospitals in the 10 years after the 1999 IOM report. They found that the overall rate of harms, and the rate of preventable harms, did not significantly improve over that period.
    • 2013. A study in the BMJ estimated that in 2013, that figure had risen to 251,454, making preventable medical errors in hospitals the third-largest cause of death in the U.S. Aaron Carroll has provided a useful critique and perspective on these figures (8.15.16).
  • Medicare Patients. A 2010 DHHS Inspector General report concluded that medical errors contributed to approximately 180 ,000 deaths.

Cost

  • According to a 2010 actuarial analysis, avoidable medical errors conservatively added $19.5 billion to the health care costs in the United States in 2008, including treatment of 6.3 million medical injuries, at least 1.5 million of which were associated with medical errors. Shreve J, van Den Bos J, Gray T, Halford M, Rustagi K, Ziemkiewicz E . The Economic Measurement of Medical Errors. Schaumberg, IL: Society of Actuaries; 2010.
  • Who Pays?  In cases of negligence, a malpractice lawsuit may be filed. “But this can take time and money. And lawyers who collect only when there’s a settlement or victory may not want to take on a case unless it’s exceptionally clear that the doctor or hospital is at fault.”  According to Kaiser Health News, “There’s no hard-and-fast rule for how hospitals handle cost of care when patients have bad outcomes and fault is disputed, said Nancy Foster, vice president of quality and patient safety policy at the American Hospital Association. Since cases vary, she added, what’s best one time may not always be.”
    • Some hospitals have rules requiring they tell patients if something went wrong and, to the best of their knowledge, why. Typically, those stipulate that if the hospital finds it erred, necessary follow-up care is free”  (Kaiser Health News, 11.11.15).
    • Most hospitals don’t have this kind of disclosure policy, said Julia Hallisy, a patient safety advocate from California. That may change: A number of professional and safety groups are urging more hospitals to adopt them. Supporters include the American College of Obstetricians and Gynecologists, the American Medical Association, Leapfrog, the National Quality Forum and the Joint Commission, which accredits many health-care organizations. The federal Agency for Healthcare Research and Quality is also on board. But even when they tell patients something went wrong, hospitals may say it was unavoidable. Then, patients often pay for the consequences, themselves or through insurance (Kaiser Health News, 11.11.15).
    • Medicare Policy. Medicare won’t pay for treatments that are fixing certain errors, like surgery on the wrong part of a patient’s body or a blood transfusion of the wrong type. And hospitals can’t charge patients – they must cover the costs themselves (Kaiser Health News, 11.11.15).
    • Medicaid Policy. The 2010 Affordable Care Act “requires Medicaid implement a similar policy, which may be easier in theory than in practice, said Rachel Morgan, health and human services committee director at the National Conference of State Legislatures. It takes time and requires expertise for state Medicaid agencies to review hospital charges and then determine if the services were in fact the result of error. That extra work makes enforcing these rules difficult – so while some states have had success doing so, others haven’t, Morgan said. Some commercial insurers are also experimenting with comparable policies, she added” (Kaiser Health News, 11.11.15).

Causes

In a new book, Ending Medical Reversal, “Dr. Prasad and Dr. Cifu extrapolate from past reversals to conclude that about 40 percent of what we consider state-of-the-art health care is likely to turn out to be unhelpful or actually harmful…The single thing that all the abandoned drugs and treatments on the authors’ list have in common is that they are all reasonable, logical and scientifically appealing. Every one of them should work” (New York Times, 10.30.15).

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