Helen Haskell on Medical Errors: New Tools Capture the Latest Tolls of Medical Harm
This is the second part of a guest post by Helen Haskell on tracking medical harm. The first part ran on Friday.
In 2010 and 2011, three much-anticipated new studies on medical harm appeared within six months of each other.
These three studies, published by the Health and Human Services Office of Inspector General, the New England Journal of Medicine, and the journal Health Affairs, provided a welcome update to the venerable Institute of Medicine (IOM) numbers from the oft quoted “To Err Is Human” report.
All three studies used a system called the Global Trigger Tool, developed by the Institute for Healthcare Improvement to mine medical records for signs (“triggers”) of potential adverse medical events. All found exponentially greater levels of harm than had been reported by the IOM.
The Inspector General reported that more than 1 in 4 hospitalized Medicare beneficiaries suffered adverse medical events resulting in some degree of medical harm, and that an estimated 180,000 Medicare beneficiaries a year died from their medical care.
The Health Affairs study found that one third of admitted patients in three large teaching hospitals suffered medical harm, with many experiencing multiple events. Most of these incidents were flying under the radar, the researchers found. The team from the University of Utah, the Institute for Healthcare Improvement, Missouri Baptist Medical Center, Brigham and Women’s Hospital, and Intermountain Healthcare wrote:
We found that the adverse event detection methods commonly used to track patient safety in the United States today—voluntary reporting and the Agency for Healthcare Research and Quality’s Patient Safety Indicators—fared very poorly compared to other methods and missed 90 percent of the adverse events. The Institute for Healthcare Improvement’s Global Trigger Tool found at least ten times more confirmed, serious events than these other methods.
In the New England Journal of Medicine study, 18.1% of patients in ten North Carolina hospitals were found to have experienced one or more adverse medical events. The authors also found that there was no significant change in the rate of harm over the six years of the study from 2002 to 2007. Given that the “To Err Is Human” report from 1999 is often referred to as a “wake up call” for the health care system, the lack of change over that time indicates that some were slow to wake up. The team from Harvard Medical School, the Institute for Healthcare Improvement, the Pardee RAND Graduate School, and Lucile Packard Children's Hospital wrote:
Though disappointing, the absence of apparent improvement is not entirely surprising. Despite substantial resource allocation and efforts to draw attention to the patient-safety epidemic on the part of government agencies, health care regulators, and private organizations, the penetration of evidence-based safety practices has been quite modest. For example, only 1.5% of hospitals in the United States have implemented a comprehensive system of electronic medical records, and only 9.1% have even basic electronic record keeping in place; only 17% have computerized provider order entry. Physicians-in-training and nurses alike routinely work hours in excess of those proven to be safe. Compliance with even simple interventions such as hand washing is poor in many centers.
Taken together, the three studies paint a fairly consistent picture of medical harm. But, here too, the findings are limited by age. The most current study is the Inspector General’s report, which analyzes patient records from 2008, and the least current is theHealth Affairsstudy, which uses 2004 records.
Although 4-year-old and 8-year-old numbers are a big improvement over numbers from two or three decades ago, much has changed even in the past few years. Some of those changes could be driving those estimates of harm up, while others could drive them down.
On the negative side, medicine has become increasingly corporate. There has been a lot of consolidation in the industry, and even nonprofit health care institutions have shifted to a bottom-line mindset. This can result in pressure to do more with less in a field in which personal attention still counts for everything.
Also, the number of medical encounters has increased, but most of them now take place outside hospitals, in clinics and doctors’ offices where safety cannot yet be tracked. Surgeries that used to involve a large staff in a hospital OR are now done by two or three people in a strip mall office that may never have been visited by a regulator or accrediting agency.
And as hospitals develop programs for dealing with certain types of infections, other newly virulent ones, like Clostridium difficile, are on the rise. At the same time, proven infection-containment measures like screening and isolation are intermittently and ineffectively employed.
Counterbalancing this is an increasing sense of urgency about medical harm, a move toward greater transparency and a heightened level of involvement by regulators and the public. I will discuss these in the next post.
Easing the Harm From Medical Errors: Q&A with Sorry Works! Founder Doug Wojcieszak
Apology as Cure: Finding the Secret Ingredients to Make "Sorry" Really Work
Apology as Cure: Dig into Data to Find Number of Patients Harmed