Medical errors may be third leading cause of death in the U.S.
According to researchers at Johns Hopkins, medical errors may actually be the third leading cause of death in this country. The study, published in the British Medical Journal (BMJ), calls attention to the inadequacies of death certificates in correctly identifying an individual’s cause of death due to medical errors; and recommends changes for measuring national vital statistics to facilitate better understanding of deaths due to medical care.
This research is a welcome addition to the line of studies that follow the landmark publication, To Err is Human: Building a Safer Health System issued in 1999 by the U.S. Institute of Medicine (IOM) that increased awareness of U.S. medical errors, which concluded that between 44,000 to 98,000 people die each year as a result of preventable medical errors. As a result of that study, many states, including Pennsylvania, and the federal government passed legislation designed to reduce and eliminate medical errors by identifying problems and recommending solutions that promote patient safety and cost-effective quality health care. Notwithstanding lawmakers’ efforts, it appears that much more needs to be done as the number of medical errors in this country continue to be at unacceptable levels. For instance, in 2004, the Agency for Healthcare Quality and Research (AHQR), in the Medicare population, estimated that 575,000 deaths were caused by medical error between 2000 and 2002, which is about 195,000 deaths a year. Similarly, the U.S. Department of Health and Human Services (DHHS) Office of the Inspector General, examining the health records of hospital inpatients in 2008, reported 180,000 deaths due to medical error a year among Medicare beneficiaries alone. Still others believe the number to be over 400,000 deaths a year, more than four times the IOM estimate.
As noted above, the BMJ study highlights concerns regarding death certificates. The primary limitation with the death certificate is that “medical error” is not included on death certificates or in rankings of cause of death; therefore, deaths caused by human and system factors, are not captured. The authors of the study contend that because, the “science of safety has matured to describe how communication breakdowns, diagnostic errors, poor judgment, and inadequate skill can directly result in patient harm and death,” this data should be incorporated into the death certificates to promote better informed healthcare research and awareness priorities.
To illustrate the problem, the study’s authors cite to the following case report:
Case history: A young woman recovered well after a successful transplant operation. However, she was readmitted for non-specific complaints that were evaluated with extensive tests, some of which were unnecessary, including a pericardiocentesis. She was discharged but came back to the hospital days later with intraabdominal hemorrhage and cardiopulmonary arrest. An autopsy revealed that the needle inserted during the pericardiocentesis grazed the liver causing a pseudoaneurysm that resulted in subsequent rupture and death. The death certificate listed the cause of death as cardiovascular.
In this instance, while the reported cause of death is correct, it does not shed any light as to the root cause of the cardiovascular issue. As such, an opportunity is lost for the CDC, DHHS, AHQR, and other health care industry think tanks to evaluate the problem and develop recommendations that might reduce or eliminate this preventable medical error. The authors of the study also describe the unfortunate reality of so called “peer review” process, which provides the health care industry with broad protection in disclosing information surrounding medical errors. According to the authors, many preventable medical errors are not investigated and examined during the peer review process, and often times when it is done, the corrective action plans are insufficient or simply not implemented with the force they deserve. Until the healthcare industry gets serious about transparency, families will continue to be left in the dark; errors will be repeated, others will die and the cost of healthcare will continue to rise.
