Harmful errors still common in U.S. hospitals: study

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Harmful errors and accidents remain common in U.S. hospitals despite a decade of efforts to improve patient safety, a study found.

According to the study, published in the New England Journal of Medicine, the number of patients experiencing hospital acquired infections, medication errors, complications from diagnostic techniques or treatments, and other such “harms” did not change between 2002 and 2007.

Medical complications, some of which are preventable, can prove costly. The U.S. Office of the Inspector General released a report recently estimating that complications contribute to 180,000 patient deaths per year and overall, cost Medicare up to $4.4 billion annually.

A team led by Christopher Landrigan, at Brigham and Women’s Hospital in Boston, looked at 2,300 patient admission records from 10 randomly selected hospitals in North Carolina.

They found 588 incidents of patient harm resulting from medical procedures, medications or other causes, with two-thirds of these complications considered preventable by researchers at the hospitals themselves.

“These harms are still very common, and there’s no evidence that they’re improving,” said Landrigan.

“The problem is that the methods that have been best proven to improve care have not been implemented across the nation.”

These methods include computerizing patient records and drug prescription orders, limiting the number of consecutive hours that residents and nurses work, and using checklists for surgical procedures, among others.

Another method is using a standardized checklist developed by Johns Hopkins to reduce bloodstream infections, with Landrigan noting that hospitals in Michigan that have used the list have kept the number of infections to nearly zero over three years.

The study found that hospital-acquired infections were one of the most common complications, but the types of harm done to patients varied widely and included falls, unintended injury during surgery, low blood pressure and low blood sugar.

Close to 85 percent were treatable and temporary, but 3 percent were permanent, 8.5 percent were deemed life-threatening, and 2.4 percent “caused or contributed to a patient’s death.”

While some patient care specialists said advances had been made simply by increasing hospital awareness of patient safety over the last ten years, others said more needed to be done—and that a “cultural shift” in hospitals and other care centers was needed.

“In order to change the way we do things, we have to work effectively as teams, and to become a good team is difficult in healthcare because that’s not how it’s set up, that’s not how we train our doctors,” said Lucian Leape, a health policy analyst at Harvard University and adviser for the recent study.

But he added that patients also needed to become more pro-active, by doing things such as asking doctors to make sure they’d washed their hands or talking with doctors about drug interactions.

“Some patients are uncomfortable doing that, but asking a doctor to double check something isn’t insulting them, it’s just recognizing that mistakes can be made,” he said.

SOURCE: The New England Journal of Medicine

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