According to a study in Journal of Patient Safety, “A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care,” deaths from medical errors in the U.S. may be between 210,000 and 440,000 patients each year.
These numbers suggest that medical errors should be the third-leading cause of death in the U.S. behind heart disease (596,577) and cancer (576,691). Previously, in 1999 the Institute of Medicine published “To Err is Human” report which stated 98,000 people a year die because of mistakes in hospitals. That number was also originally disputed by doctors and hospital officials, but has now been widely accepted.
John T. James, PhD, who was a toxicologist at NASA’s space center in Houston until he retired this year to work full-time on improving patient safety, developed the new estimates. He runs an advocacy organization called Patient Safety America and has written a book about the death of his 19-year-old son from negligent hospital care.
James based his estimate on the findings of four recent studies that identified preventable harm suffered by patients, otherwise known as “adverse events.” He used a screening method called the Global Trigger Tool, which measures adverse events, guiding reviewers through medical records, and searching for signs of infection, injury or error. The medical records flagged during the initial screening were reviewed by a doctor, who determined the extent of the harm.
The four studies examined records for more than 4,200 patients hospitalized from 2002 and 2008. Researchers found serious adverse events in as many as 21 percent of cases reviewed and rates of lethal adverse events as high as 1.4 percent of cases. James combined the findings and applied them to 34 million hospitalizations in 2007, reaching the conclusion that preventable errors contribute to the deaths of 210,000 hospital patients on an annual basis. James then reasoned that the number more than doubles because the trigger tool does not catch all errors, such as diagnostic errors. In addition, James cited other research showing hospital reporting systems and peer-review capture only a fraction of patient harm or negligent care.
A spokesperson from the American Hospital Association said the group is confident that the IOM’s estimate of 98,000 deaths is correct. However, ProPublica (an independent, non-profit newsroom that produces investigative journalism in the public interest) asked three prominent patient safety researchers to review James’ study and all said his methods and findings were credible. In addition, Dr. Lucien Leape who was on the committee that wrote the “To Err is Human” report told ProPublica that he has confidence in the four studies and estimate by James.
For now, the correct number of patient deaths from preventable errors is unknown. The only information available is rough estimates, which are imperfect because of inaccuracies in medical records and the reluctance of some providers to report mistakes. However, Dr. David Mayer, the vice president of quality and safety of MedStar Health, believes that arguments about how many patient deaths are hastened by poor hospital care is not really the point because even low estimates expose a crisis.
Written by James P. Nevin