By Stacey Eccleston
Program Implementation and Research Leader
The data is in!—an astounding 400,000+ patients die each year related to preventable harm occurring at hospitals across the U.S. This puts medical errors at the third leading cause of death in the U.S. The new 2013 study from the Journal of Patient Safety updates the nearly 3 decade-old figures estimated by the Institute of Medicine and should certainly cause alarm. I know it did for me. But what can we as patients do to avoid becoming part of that statistic? Where does the responsibility lie for reducing that number? Were the adverse events that led to the deaths truly avoidable?
I think the answer to the third question for the most part is a resounding yes. Certainly not all adverse events are preventable, but the methods used for the most recent statistics are designed to narrow in on the 50 to 60% of events that are deemed preventable. The preventable harm we are talking about here includes such things as errors in execution of a procedure, say accidental nicks or improper handling of equipment that lead to serious infections; errors in communication where important information is not conveyed to patients or caregivers that is vital to recovery and patient safety; and errors in diagnosis. True, these are certainly not intentional errors, but by definition should be avoidable.
Where does the responsibility lie for reducing that number? I believe the responsibility primarily lies at the feet of the healthcare provider community. The American Hospital Association did establish “strategic performance commitments” as part of its 2011-2013 strategic plan aimed at eliminating preventable mortality. But, a recent update to the Leapfrog Hospital Safety Scores showed that on average, hospital safety scores have not improved across the nation and that while hospitals are making some headway in some areas, progress in improving safety is far too slow. There are certainly some isolated pockets of innovation in improvement in patient safety. The Comprehensive Unit-based Safety Program (CUSP) at The Johns Hopkins Hospital recognizes the central importance of hospital culture in sustainable patient safety improvements and elements of that program have been very effective in significantly reducing central catheter related infections. Our nation’s hospitals need to hear the outcry and make it a priority to address the problem more broadly. The pressure needs to come from the ground up among all hospital employees as well as from the Boardroom.
The pressure too must come from patients. Patients need to be involved in their care and feel confident enough to have a voice in their care. I had an unfortunate first hand experience with a medical error that caused direct harm to me as a patient, though thankfully and obviously, not one that resulted in my death. After being plagued with back problems for much of my adult life I underwent a lumbar laminectomy of two vertebrae on my left side. Immediately following the surgery and for about 3 weeks thereafter I felt complete relief. At about 3 weeks post-surgery I started to feel pain on my right side. This went on and got increasingly worse for about another 3 weeks during which time there were several expensive diagnostic exams and visits to everyone from acupuncturists to chiropractors to pain clinics. My surgeon noted that it could not possibly be a surgical related infection because I would be in more pain than I was exhibiting and prescribed pain medication and antidepressants. I of course thought he must be right; I was, after all, somewhat ambulatory. Nonetheless, I kept pushing to get at the cause of the pain because it prevented me from working. After a spine biopsy, it was discovered that there was indeed an infection that was introduced at the time of the original surgery. I was promptly hospitalized and put on a intra-venous course of antibiotics that continued for 8 weeks post discharge. I tell this story because it did take some persistence on my part to push for the diagnosis of the infection. I am not sure all patients feel empowered to do so; in fact, I was constantly second-guessing myself.
The error during surgery as well as the subsequent misdiagnoses of the infection falls into the category of preventable error that caused harm. In this case, thankfully, that harm did not result in death, unlike it did for an unfortunate 400,000 other of our nations residents.