Medical errors the 3rd leading cause of death??

Dogen · May 7, 2016

I aspire to avoid errors in the way they're defined by James Reason and the IHI: slips, lapses, mistakes, and violations.

Slips - An action which is executed in a way other than intended. Pushing a wrong button, Freudian slips, etc.

Lapses - A lapse of memory or attention that leads to an incorrect action or inaction, such as forgetting to double check a dosage before administering or forgetting to check on a patient.

Mistakes - Doing something believed to be correct when it is not, as a result of poor planning or an incorrect intention, such as guessing your patient with acute changes in LOC is having a stroke and not checking a CBG.

Violations - Intentionally not following established procedures, such as shutting off telemetry alarms.

These are separate from harm. Not all errors result in harm, and not all harm is caused by an error. Avoiding errors minimizes but doesn't eliminate the risk of harm. Our example of a pericadiocentesis may have been performed correctly and still resulted in harm due to variables that weren't foreseeable, or it may have been the result of an error that led to harm (such as not using ultrasound if it's hospital policy). When discussing the rate of deaths from medical errors I think these definitions of error are especially important so that we know we're discussing human or systemic failures that might be addressed versus the limits of medical science and variation in human anatomy and physiology that we can't control.

nutella, MSN, RN · May 7, 2016

The numbers that the IOM published many years ago estimated already back at that time close to 100 000 people dying as a result of the healthcare they are receiving. Since that time a lot of things have changed - and not for the better when it comes to errors. Patients are more complex cases, transition through the healthcare system more frequently, nurses are short staffed more and more, professionals now working in silos... So it is somewhat logical to believe that errors would be more frequent despite all the safety mechanism we now have including smart pumps, barcode assisted medication administration and so on.

From everything I am seeing on a daily base I would say that lack of communication between professionals, lack of communication in transitions, and lack of communication between pat and healthcare professionals lead to errors frequently.

It is especially tragic when young people die.

Communication is a huge problem all around.

Patients who thought that cancer was removed during surgery when in fact only a biopsy was done.

Patients who do not understand their diagnosis, prognosis and treatment and do not ask or the physician did not bother to check if the patient understands.

Patients who get infections because of central lines /foley with sepsis.

Wrong diagnosis...

Narcotics without bowel meds until the pat comes in with 14 days of no BM and impending huge problems...(Pat : "what are you talking about - constipation is a side effect???").

Pat send home but oxygen company was not able to deliver oxygen home that day.

And the list goes on and on - I can not give concrete examples from recent months due to confidentiality concerns but I can assure you that on a daily base something get identified that is problematic.

It is even more concerning when it is your family.

I have 2 examples from my own health.

I was pregnant with my first child, gained weight up to 10 lb in one week with BP going high - I received diet counseling and was chastised by the MD for "eating too much" - go figure the end of the story was emergency c section and my on a betablocker drip due to BP 250 after c-section. I was young and had heart racing and near syncope several times - due to my age I was diagnosed with "young and anxious" which did not fit at all. However, after it got worse I went to the EP lab and low and behold was found to have SVT with pathway that got cooked - no SVTs since.

My husband had to get iv steroids for something years ago, which lead to a high blood sugar. The MD did not want to discharge him due to his blood sugar in the 300 s requiring insulin. Go figure - I come in at lunchtime and my husband is eating highcarb meal, apple juice, chocolate cake and so on - regular diet ...I pointed that out to the MD and nurse and insisted on D/C - my h was not a diabetic and had no clue.

James W. · May 7, 2016

On a lighter note..

Who hasn't seen the Steve Martin classic movie,

'The Man with Two Brains' - wherein Steve is a neurosurgeon,

& makes comments during a conference presentation speech..

..along the lines of..

"Death as treatment outcome, is never acceptable..

..unless its as a result of our own incompetence."

Perhaps the reality is - that to a statistically significant extent,

'Medical Science' may be an oxymoron, like 'Military Intelligence'.

offlabel · May 8, 2016

Funny how you present your opinion as fact. Please do elaborate. Exactly which hidden agenda is it that you believe the authors of the BMJ article are promoting?
Isn't it true that the BMJ article lists several existing definitions of the term "medical error"?
Medical errorâ€”the third leading cause of death in the US | The BMJ
and they conclude by stating:
The BMJ article is an analysis of some of the previously conducted research in the area of medical errors. In order to see which exact definition of the term "medical error" was used in the respective studies referenced, one would have to look at them individually.
Here's one from the BMJ article's reference list:
â€˜Global Trigger Tool' Shows That Adverse Events In Hospitals May Be Ten Times Greater Than Previously Measured
This article looks at adverse events in the following categories; medication-related, procedure-related(excluding infection), nosocomial infection, pulmonary/VTE, pressure ulcers, device failure, patient falls and other.
As I understand the BMJ article, one of the major challenges when attempting to ascertain the number of patients who die as a direct result from a preventable medical error or when a medical error in some part may have contributed to or accelerated the patient's demise is that:
And they identify the following potential obstacle to learning from the mistakes of others in order to minimize future errors which may result in harm to patients.
In my personal opinion, only a fool would argue that medical errors don't in some instances cause temporary harm, permanent harm or even death to patients. Identifying the exact number of deaths caused is of course extremely difficult, and the numbers will likely be extrapolated from various studies. There will always be a margin of error/uncertainty.
Factors like communications breakdown, inadequate staff-patient ratios, stress, inadequate skill and procedural mistakes all have the potential to result in patient harm and/or death. The question is, what can we as individual healthcare professionals do to minimize the risk of adverse events occurring? What can be done on an organizational/systems level?
Does it really matter if medical errors is the third leading cause of deaths or "only" the fifth or sixth? I'm certain that there is room for improvement in either case.

I think you're disagreeing with me, but you're proving my point . Did you read their definition of an error? By it, a patient can actually benefit and still his care will qualify as an error.

I'm interested in all of the concern for medical errors in the UK and Canada. Where are all of those papers? Think there might be any relation to the fact that the US isn't a universal health care system yet gets all of the attention with regard to error. Of course it's a problem, but if anyone is gullible enough to believe the claims of this paper, there's a bridge for sale in Brooklyn.

TheCommuter, BSN, RN · May 8, 2016

Moved to Nursing News forum for more responses.

DoGoodThenGo · May 19, 2016

From WSJ opinion article published on 18 May 2016 entitled "How To Make Hospitals Less Deadly"

Item: 700,000 patients become infected each year in hospitals, 75,000 of them die as a result.

Item: Bed sores kill 60,000 annually and wound 2.5 million

Item: Erroneous medication orders kill "thousands of Americans" annually.

Item: Diagnostic errors in outpatient settings (such as failure to detect a cancerous lesion cause "some 100,000 deaths per year.."

allnurses Guide · May 19, 2016

From WSJ opinion article published on 18 May 2016 entitled "How To Make Hospitals Less Deadly"
Item: 700,000 patients become infected each year in hospitals, 75,000 of them die as a result.
Item: Bed sores kill 60,000 annually and wound 2.5 million
Item: Erroneous medication orders kill "thousands of Americans" annually.
Item: Diagnostic errors in outpatient settings (such as failure to detect a cancerous lesion cause "some 100,000 deaths per year.."

I worry what the general public thinks when they read things like this. I worry that it hinders individuals from getting appropriate primary care.

The numbers are staggering, and while we need to make sure we are taking ever precaution to reduce them, there will always be errors, and the risk of those errors doesn't outweigh the benefit of treatment, especially primary prevention.

ShaneTeam · May 20, 2016

I worry what the general public thinks when they read things like this. I worry that it hinders individuals from getting appropriate primary care.
The numbers are staggering, and while we need to make sure we are taking ever precaution to reduce them, there will always be errors, and the risk of those errors doesn't outweigh the benefit of treatment, especially primary prevention.

And, the weird thing is, we are only talking about a 1.6% error rate. I, personally, would just like to see the type of funds going to reduce the numbers of mistakes. Oh, and on a side note, if you watch House, it shows 3 or 4 medical errors before proper diagnosis is made.

DoGoodThenGo · May 24, 2016

And, the weird thing is, we are only talking about a 1.6% error rate. I, personally, would just like to see the type of funds going to reduce the numbers of mistakes. Oh, and on a side note, if you watch House, it shows 3 or 4 medical errors before proper diagnosis is made.

It is "only" a 1.6% error rate when those numbers do not affect you or your family. When the error does hit home you have stories that reach the media like this: Brooklyn grandmother died of meningitis after misdiagnosis - NY Daily News

Then you have the sad case of Rory Staunton which spread from New York City and State to federal and even worldwide levels. In the process several physicians, and members of nursing staff (who IIRC were named publically in local NYC news media) had their personal and professional lives turned upside down. Rory Staunton - Wikipedia, the free encyclopedia

Yes, mistakes happen, but they mustn't happen too often.

allnurses Guide · May 24, 2016

Failing to notice a profound leukocytosis is absolutely an error and and error that should have been avoided; most facilities have a protocol for reporting and documenting critical labs.

But it also highlights one of the more difficult aspects of medicine: there are harms in over-testing and harms in under-testing so a fien line needs to be walked and providers need to mix both the science (EBP) and the practice (the art) of medicine.

DoGoodThenGo · May 24, 2016

Failing to notice a profound leukocytosis is absolutely an error and and error that should have been avoided; most facilities have a protocol for reporting and documenting critical labs.
But it also highlights one of the more difficult aspects of medicine: there are harms in over-testing and harms in under-testing so a fien line needs to be walked and providers need to mix both the science (EBP) and the practice (the art) of medicine.

Well the profound leukocytosis might have been noticed in this case had anyone bothered to look at the lab results; but apparently that did not happen. IIRC it took five hours for the results to make their way back to the ER. By that time the kid had been discharged with the standard "take Tylenol and call your physician or return if conditions do not improve...."

Rory Staunton: Boy, 12, dies after 'doctors fail to spot infection ravaging his body' | Daily Mail Online

In the orgy of public shaming and blaming that NYU took the nurse got hit because she did the discharge (IIRC); while the ER doctors were crucified for what the family and media mostly considered gross malpractice. Remember hearing a few months later the PR/communications person for NYU during this whole thing was fired or otherwise left but it was "supposedly" unrelated to the RS case. Jim Dwyer New York Times Pediatric Fever Article Debate - Emergency Physicians Monthly

allnurses Guide · May 25, 2016

Well the profound leukocytosis might have been noticed in this case had anyone bothered to look at the lab results; but apparently that did not happen. IIRC it took five hours for the results to make their way back to the ER. By that time the kid had been discharged with the standard "take Tylenol and call your physician or return if conditions do not improve...."

I just read through some of the details, out of curiosity, and there seem to be many errors, and all seem (to me) to stem from pigeon-holing the diagnosis, and later snowball into a major mistake. I speak to my student about this (both medical and NP) because it can ruin a career or result in a loss of life. You can never enter a room to assess a patient with a preconceived diagnosis. If the peditrician called an expect into the ED for the patient "to get fluids for a GI illness" (which makes some medical sense, gastroenteritis leads to hypovolemia and subsequent hypotension and reflex tachycardia) and that ED provider entered the room with the notion the patient only needed fluids, a mistake was ripe to happen.

Then it is compounded by a lab result taking 3 hours, shift change, and the failure to notice/communicate that the fluid resuscitation did not improve the tachycardia, failure to call a critical lab, etc.

I just wonder if it could have been avoided if the ED provider was more suspicious on initial evaluation. Although in his defense, it seems to lay people to be unfathomable to misdiagnose sepsis as gastroenteritis, but the truth is that the presentation for many rare and dangerous conditions is very similar or exactly the same as much more commonplace benign illness.