Dr Rick

There has been no end to the controversy surrounding the Institute of Medicine's report on the impact of medical errors.

Hosp Case Manag 2000 Oct;8(10):suppl 3-4, 146

University study identifies problems with IOM report.

The Institute of Medicine's (IOM) report on medical errors is faulty because it does not include a control group and all the patients studied were 'very sick' according to researchers at Indiana University. "What the figures suggest is that people don't die [without an adverse event]," says Clement J. McDonald, MD, director of the Regenstrief Institute and Distinguished Professor of Medicine at Indiana University School of Medicine in Indianapolis. McDonald is referring to the study released by the IOM of the National Academies in November that states 'preventable adverse events are a leading cause of death' and 'at least 44,000 and perhaps as many as 98,000 Americans die in hospitals each year as a result of medical errors.


Journal of the American Medical Association 2001

Estimating hospital deaths due to medical errors: preventability is in the eye of the reviewer.

Hayward RA, Hofer TP.

CONTEXT: Studies using physician implicit review have suggested that the number of deaths due to medical errors in US hospitals is extremely high. However, some have questioned the validity of these estimates. OBJECTIVE: To examine the reliability of reviewer ratings of medical error and the implications of a death described as "preventable by better care" in terms of the probability of immediate and short-term survival if care had been optimal. DESIGN: Retrospective implicit review of medical records from 1995-1996. SETTING AND PARTICIPANTS: Fourteen board-certified, trained internists used a previously tested structured implicit review instrument to conduct 383 reviews of 111 hospital deaths at 7 Department of Veterans Affairs medical centers, oversampling for markers previously found to be associated with high rates of preventable deaths. Patients considered terminally ill who received comfort care only were excluded. MAIN OUTCOME MEASURES: Reviewer estimates of whether deaths could have been prevented by optimal care (rated on a 5-point scale) and of the probability that patients would have lived to discharge or for 3 months or more if care had been optimal (rated from 0%-100%). RESULTS: Similar to previous studies, almost a quarter (22.7%) of active-care patient deaths were rated as at least possibly preventable by optimal care, with 6.0% rated as probably or definitely preventable. Interrater reliability for these ratings was also similar to previous studies (0.34 for 2 reviewers). The reviewers' estimates of the percentage of patients who would have left the hospital alive had optimal care been provided was 6.0% (95% confidence interval [CI], 3.4%-8.6%). However, after considering 3-month prognosis and adjusting for the variability and skewness of reviewers' ratings, clinicians estimated that only 0.5% (95% CI, 0.3%-0.7%) of patients who died would have lived 3 months or more in good cognitive health if care had been optimal, representing roughly 1 patient per 10 000 admissions to the study hospitals. CONCLUSIONS: Medical errors are a major concern regardless of patients' life expectancies, but our study suggests that previous interpretations of medical error statistics are probably misleading. Our data place the estimates of preventable deaths in context, pointing out the limitations of this means of identifying medical errors and assessing their potential implications for patient outcomes.

Eff Clin Pract 2000 Nov-Dec;3(6):277-83

How many deaths are due to medical error? Getting the number right.

Sox Jr HC, Woloshin S.

Dartmouth Medical School, Hanover, NH, USA.

CONTEXT: The Institute of Medicine (IOM) report on medical errors created an intense public response by stating that between 44,000 and 98,000 hospitalized Americans die each year as a result of preventable medical errors. OBJECTIVE: To determine how well the IOM committee documented its estimates and how valid they were. METHODS: We reviewed the studies cited in the IOM committee's report and related published articles. RESULTS: The two studies cited by the IOM committee substantiate its statement that adverse events occur in 2.9% to 3.7% of hospital admissions. Supporting data for the assertion that about half of these adverse events are preventable are less clear. In fact, the original studies cited did not define preventable adverse events, and the reliability of subjective judgments about preventability was not formally assessed. The committee's estimate of the number of preventable deaths due to medical errors is least substantiated. The methods used to estimate the upper bound of the estimate (98,000 preventable deaths) were highly subjective, and their reliability and reproducibility are unknown, as are the methods used to estimate the lower bound (44,000 deaths). CONCLUSION: Using the published literature, we could not confirm the Institute of Medicine's reported number of deaths due to medical errors. Due to the potential impact of this number on policy, it is unfortunate that the IOM's estimate is not well substantiated.

Am J Med Qual 2000 Nov-Dec;15(6):263-6

Commentary: to err is human--but not in health care.

Forkner-Dunn DJ.

KP Online, Kaiser Permanente Medical Care Program, 1800 Harrison St, 18th Floor, Oakland, CA 94612, USA.

Despite high levels of competence and dedication among health care professionals, human error causes many deaths each year. Unlike other industries, however, the health care industry treats mistakes as personal failures of the clinician instead of system-related issues. To assist patients, their families, and clinicians, healing institutions should improve error-prevention systems, while embracing a more accepting view of human fallibility.

Eff Clin Pract 2000 Nov-Dec;3(6):261-9

What is an error?

Hofer TP, Kerr EA, Hayward RA.

Department of Veterans Affairs, VA Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, Mich., USA.

CONTEXT: Launched by the Institute of Medicine's report, "To Err is Human," the reduction of medical errors has become a top agenda item for virtually every part of the U.S. health care system. OBJECTIVE: To identify existing definitions of error, to determine the major issues in measuring errors, and to present recommendations for how best to proceed. DATA SOURCE: Medical literature on errors as well as the sociology and industrial psychology literature cited therein. RESULTS: We have four principal observations. First, errors have been defined in terms of failed processes without any link to subsequent harm. Second, only a few studies have actually measured errors, and these have not described the reliability of the measurement. Third, no studies directly examine the relationship between errors and adverse events. Fourth, the value of pursuing latent system errors (a concept pertaining to small, often trivial structure and process problems that interact in complex ways to produce catastrophe) using case studies or root cause analysis has not been demonstrated in either the medical or nonmedical literature. CONCLUSION: Medical error should be defined in terms of failed processes that are clearly linked to adverse outcomes. Efforts to reduce errors should be proportional to their impact on outcomes (preventable morbidity, mortality, and patient satisfaction) and the cost of preventing them. The error and the quality movements are analogous and require the same rigorous epidemiologic approach to establish which relationships are causal.

Proxima Centauri

Healthy young people, eg of 25 should pay willingly for the lhealth care of older/sicker people. They should be grateful for their health.

Jimmy Higgins

Being the socialist I am, I do. My problem is that the costs are skyrocketing and no one seems to care!

Gurdur

Emigrate.

I live somewhere where I receive topnotch (if occasionally silly) health care and dental care, and I only pay a reasonable amount per month; and I'm not even a bloody citizen of the bloody place.

If I was a citizen, my costs would be lower than they are now; but even so, I'm paying quite a reasonably small amount, so I'm not complaining.

No citizens here fall through the gaps; the poorest get it all completely free.

Loren Pechtel

Hey! How about a reason for this!

John Hancock

HMO'S and Foxey lockxey Frist fast twix predatory Insurance and us the fine & obese.

Martin Buber