Scant progress seen on cutting medical errors

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Five years after a major report describing an epidemic of medical errors in the U.S. health care system shocked patients, policy makers and physicians, little substantial progress has been made to make medical care safer, experts said Thursday.

Observers cite a lack of money and political will needed to fund safety research and implement safeguards in hospitals and physicians’ offices throughout the nation.

They also point to a resistant medical culture in which doctors still balk at efforts to record errors and participate in systematic steps to solve them.

The Institute of Medicine issued a report in November 1999 warning that outdated and sometimes nonexistent safety practices were causing widespread errors in pharmacies, doctors’ offices and operating rooms throughout the country.

The report, believed to be among the most widely read in the institute’s history, claimed that between 44,000 and 98,000 Americans die each year because of preventable medical mistakes.

Those numbers echoed on Capitol Hill and elsewhere as policy makers vowed to launch a national effort to address the problem. However, legislation aimed at mandating error reporting has languished for years as lawmakers disagree over whether the data should be kept secret.

Five years later, there’s little to show progress, and researchers are still debating not how to save lives, but what to measure in the first place.

“Let’s not kid ourselves about what’s happening,” said Dr. Lucian L Leape, who sat on the committee that issued the 1999 report, called “To Err is Human: Building a Safer Health System.”

“We don’t have a national effort for patient safety,” the Harvard University health policy professor said. Leape and others point to government research funding that they say is scant given the high number of deaths caused by medical mistakes.

The Agency for Healthcare Research and Quality, the body responsible for health safety studies, has a budget this year of only $60 million. “Dollars have not materialized to do what needs to be done,” Leape said at a conference commemorating the report’s anniversary.

Dr. Robert M. Wachter, who co-authored the report, said that “a little bit” of progress has been made in US hospitals since 1999. “But the difference is not striking,” he commented.

Wachter described a survey of 400 hospital physicians in which 45 percent said that their facility has a better culture of safety than it did in 1999. The other 55 percent said that it has stayed the same or gotten worse.

Wachter praised private organizations like the Joint Committee for Accreditation of Hospital Organizations for tightening safety practices in the hospitals it monitors. But even this organization has been criticized for keeping most of its data secret, while most advocates believe public reporting of safety data is needed to drive doctors and hospitals to improve.

Many states and private health systems now require health workers to report medical errors or “near misses,” in which a patient is put at potential risk. But researchers still have largely not figured out what to do with the reports once they have them, Wachter pointed out.

“There are still a lot of reports that sit on a shelf somewhere and they have not been translated into action,” he said.

“Doctors and hospitals don’t like to look bad in relation to their colleagues,” said Arthur Levin, director of the Center for Medical Consumers, a New-York-based advocacy group.

Doctors also may not like the idea of sharing authority with professionals who have less training. The 1999 report called for more widespread training to teach doctors, nurses and other health professionals to loosen traditional hierarchies and function as a team, much as airline pilots do.

Advocates favor the approach, saying such a system promotes checks and balances that help avoid errors while keeping the airline captain in charge—but evidence is “marginal” that facilities are adopting it, according to Wachter.

He cited a 2000 study in which 50 percent of surgeons but less than 10 percent of pilots said that the decisions of the leader in their respective fields should never be questioned when making decisions.

“Virtually every pilot says, ‘of course, are you crazy? If I’m about to fly into a mountain, stop me.’ Half of surgeons say no,” he said. 

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