Medical errors cause up to 98,000 deaths and more than 1 million injuries each year in the United States

Dr. Christopher Landrigan

In 1999 a report from the Institute of Medicine stated that medical errors cause up to 98,000 deaths and more than 1 million injuries each year in the United States.  There was a major response from a number of concerned groups to improve patient safety.  Some initiatives have been demonstrated to have a positive effect.  Others have not been evaluated rigorously or have not been implemented on a wide scale.


A "Special Article" in the New England Journal of Medicine by Christopher Landrigan, et al. eloquently notes that not much improvement has actually occurred.  The article, "Temporal Trends in Rates of Patient Harm Resulting from Medical Care" is a must read for those concerned about patient safety.  Soon after it's publication, Denise Grady of the New York Times wrote an article based on the study by Dr. Landrigan.


In the decade that passed since the report from the Institute of Medicine, only 17% of hospitals have computerized systems for ordering prescriptions, which is a source of medication errors.

Regulators Probe Roche's Drug-Safety Reporting

Severin Schwan, Roche CEO 

The European Medicines Agency (EMA), which is Europe's drug regulatory authority has stated that it will investigate Roche Holding AG after it found that Roche had failed to properly evaluate approximately 80,000 cases.  Patient deaths were reported in  15,161 of these cases.

Roche has indicated that it did not comply with regulations for the reporting of safety events.  Roche stated that "the company is working closely with health authorities, including the European Medicines Agency, to implement these measures in due time."

Adverse drug reactions leading children to the Emergency Department

The aim of the study was to determine the incidence of adverse drug reactions (ADR) that led children to hospital emergency care in a university hospital in São Paulo, SP. Medical charts (MC) of patients seen at the pediatric emergency department were selected according to International Classification of Diseases (ICD) codes consistent with ADR. Of 23,286 cases studied, 2,409 records were selected. An ADR was observed in 83 (0.36%) MC. Most ADR occurred in children aged 1-5 years with a slight predominance in males (51.8%). The drugs most commonly involved were antibiotics for systemic use (53.0%), vaccines (9.6%) and analgesics (7.2%). Most ADR were dermatological (54.2%) or gastrointestinal (22.9%) manifestations. Two ADR were considered severe (2.4%) while 61.4% were mild and 36.1% were moderate. The incidence was lower than in the literature, probably because it is a retrospective study that used the ICD for selecting the data assessed. The characteristics of ADR are similar to those found in other countries. Interventions are needed to improve the diagnosis and the use of antibiotics, as they were the drugs most involved in the ADR observed. Research in hospital emergency is important to acknowledge ADR that occur outside the hospital setting and may help to identify the most severe ones. Despite limitations, the method requires few resources and materials, and is a good alternative to initial diagnosis. The present study should be followed by studies with higher sensitivity to detect these reactions in order to propose prevention measures.

Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I*

Here's an abstract of an interesting article, which first appeared in the New England Journal of Medicine and was subsequently republished:

Background: 

As part of an interdisciplinary study of medical injury and malpractice litigation, we estimated the incidence of adverse events, defined as injuries caused by medical management, and of the subgroup of such injuries that resulted from negligent or substandard care.

Methods: We reviewed 30 121 randomly selected records from 51 randomly selected acute care, nonpsychiatric hospitals in New York State in 1984. We then developed population estimates of injuries and computed rates according to the age and sex of the patients as well as the specialties of the physicians.

Results:  

Adverse events occurred in 3.7% of the hospitalizations (95% confidence interval 3.2 to 4.2), and 27.6% of the adverse events were due to negligence (95% confidence interval 22.5 to 32.6). Although 70.5% of the adverse events gave rise to disability lasting less than 6 months, 2.6% caused permanently disabling injuries and 13.6% led to death. The percentage of adverse events attributable to negligence increased in the categories of more severe injuries (Wald test x2 = 21.04, p,0.0001). Using weighted totals we estimated that among the 2 671 863 patients discharged from New York hospitals in 1984 there

were 98 609 adverse events and 27 179 adverse events involving negligence. Rates of adverse events rose with age (p,0.0001). The percentage of adverse events due to negligence was markedly higher among the elderly (p,0.01). There were significant differences in rates of adverse events among categories of clinical specialties (p,0.0001), but no differences in the percentage due to negligence.

Conclusions: There is a substantial amount of injury to patients from medical management, and many injuries are the result of substandard care.

Patient safety education for undergraduate medical students

The authors of an article published in BMC Medical Education conducted a survey of the medical literature related to patient safety education in the medical curriculum of medical schools.


The article notes that there are only a few relevant published studies on the inclusion of patient safety education in the undergraduate curriculum in medical schools either as a selective course, a lecture program, or by being integrated into the existing curriculum.  The search included developed countries with advanced health and education systems. 


It is clear that the integration of patient safety education into the existing curriculum in medical schools internationally, provides significant challenges and needs.

Medical students benefit from learning about patient safety in an interprofessional team

An article published in Medical Education by 

Elizabeth Anderson, 

Lucy Thorpe, 

David Heney and 

Stewart Petersen describes how d

elivering patient safety education interprofessionally heightens students’ awareness of the importance of effective team-working for safe care and care delivery.  This is not something that is routinely taught in either medical schools or in post-graduate training programs.  The authors conclude that designing a a workshop on team-based patient safety towards the end of medical education can enable students to assimilate all aspects of their curriculum relevant to safety. Students learn that there is a link between team factors and safety and this is increased when students learn interprofessionally.

Medical Errors Go Unreported 86% Of The Time

According to a recently released report from the Office of the Inspector General at the U.S. Department of Health and Human Services, medical errors go unreported in 86% of Medicare cases. US hospitals included in the study have incident reporting systems which are designed to capture such events.  Thirty four of the hospitals in the study noted that they "rely heavily" on the systems to find problems and make changes to improve patient safety.

http://oig.hhs.gov/oei/reports/oei-06-09-00091.pdf