1/6 of US Deaths From Hospital Errors

I don’t post on medicine much lately, because my attention has been elsewhere. But this looks too important not to mention:

In 1999, the Institute of Medicine published the famous “To Err Is Human” report, … reporting that up to 98,000 people a year die because of mistakes in hospitals. The number was initially disputed, but is now widely accepted by doctors and hospital officials — and quoted ubiquitously in the media. In 2010, the Office of Inspector General for Health and Human Services said that bad hospital care contributed to the deaths of 180,000 patients in Medicare alone in a given year.

Now comes a study in the current issue of the Journal of Patient Safety that says the numbers may be much higher — between 210,000 and 440,000 patients each year who go to the hospital for care suffer some type of preventable harm that contributes to their death, the study says.

That would make medical errors the third-leading cause of death in America, behind heart disease, which is the first, and cancer, which is second. …

James based his estimates on the findings of four recent studies that identified preventable harm suffered by patients – known as “adverse events” in the medical vernacular – using use a screening method called the Global Trigger Tool, which guides reviewers through medical records, searching for signs of infection, injury or error. Medical records flagged during the initial screening are reviewed by a doctor, who determines the extent of the harm.

In the four studies, which examined records of more than 4,200 patients hospitalized between 2002 and 2008, researchers found serious adverse events in as many as 21 percent of cases reviewed and rates of lethal adverse events as high as 1.4 percent of cases.

By combining the findings and extrapolating across 34 million hospitalizations in 2007, James concluded that preventable errors contribute to the deaths of 210,000 hospital patients annually.

That is the baseline. The actual number more than doubles, James reasoned, because the trigger tool doesn’t catch errors in which treatment should have been provided but wasn’t, because it’s known that medical records are missing some evidence of harm, and because diagnostic errors aren’t captured.

An estimate of 440,000 deaths from care in hospitals “is roughly one-sixth of all deaths that occur in the United States each year.” (more; source)

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  • http://juridicalcoherence.blogspot.com/ Stephen Diamond

    A three-fold increase in the amount of lethal malpractice in hospitals since 1999. (The default interpretation of the combined results.)

    What could be the cause? My first guess is tort reform: suing doctors has become much harder, and many lawyers who made their living off medical-malpractice litigation have switched to other torts.

    The result: doctors have become more negligent because of decreased incentive to avoid negligence.

    • IMASBA

      Or maybe very “brittle” people get more treatment than they used to

      • http://juridicalcoherence.blogspot.com/ Stephen Diamond

        The point is that we know this was a period during which tort reforms limiting malpractice suits were adopted in almost all states. (In California, a physician can–and usually does–require patients sign an agreement precluding lawsuits before treating them.) Is there any reason to think there was a dramatic upsurge in brittle people being treated? I don’t think so. Was there a lot more affirmative action during this period? I don’t think so.

      • IMASBA

        “Is there any reason to think there was a dramatic upsurge in brittle people being treated?”

        Yes.

        “The point is that we know this was a period when tort reforms limiting malpractice suits were adopted in almost all states”

        I just think it’s extremely unlikely tort reform was the major cause here. Also consider many of these “mistakes” are made by the nursing staff instead of the doctors. Plus US public hospitals are even more short on resources than they used to be.

      • http://juridicalcoherence.blogspot.com/ Stephen Diamond

        consider many of these “mistakes” are made by the nursing staff instead of the doctors

        Then the patient would have to sue the hospital, which isn’t any easier than suing a physician.

        (But the time match isn’t anywhere near as clear as I remembered. California tort reform, the model for much of it, was passed in 1975.)

      • IMASBA

        Stephen Diamond

        “Then the patient would have to sue the hospital, which isn’t any easier than suing a physician.”

        And which always has been difficult, tort reform or not…

        rrb

        New technologies mean cancer patients are treated longer and patients who weren’t treated at all because they couldn’t be saved are treated today.

      • rrb

        “Yes.”

        Can you… tell us?

      • http://juridicalcoherence.blogspot.com/ Stephen Diamond

        Plus US public hospitals are even more short on resources than they used to be.

        This is actually an important point, and perhaps the key point in considering the use Robin would make of this data. I don’t know why there would be lots more “brittle patients” in the last decade and a half, but resources have diminished. (The 1999 study was done during the “roaring 90s.”)

        Robin, we know, wants to say that there’s too much medical spending; the data could be interpreted to say there’s too little.

        [I do think tort reform has a generally deleterious effect on medical practice. It has increased the arrogance and irresponsibility of the medical profession, not only directly but by still further augmenting the status of physicians and making them still more arrogant. And I think it's inconsistent of libertarians to favor malpractice tort reform, which represents a regulatory limit on recovery for one special class of torts.]

      • IMASBA

        “Robin, we know, wants to say that there’s too much medical spending; the data could be interpreted to say there’s too little.”

        The truth lies in the middle: America spends too much money on healthcare but it does so very inefficiently and the access to and quality of the care is very unevenly distributed.

      • http://juridicalcoherence.blogspot.com/ Stephen Diamond

        I think doctors make far too much money because there are too few of them (due to rent seeking by the powerful, organized medical profession).

        Whether the result is too much or too little total spending is, I think probably impossible to say, given the extreme inefficiencies, which affect both the harms and benefits but not necessarily equally. What seems clear is that, assuming the continued expensiveness of medical technologies, as societies get richer they can and should spend a greatly expanding share of the wealth on medical care.

        It’s a simple choice, isn’t it (societally), between medicine versus huge mansions or expensive toys?

        [It seems to me that social-democratic European societies greatly *underfund* medical care, so that the fact that they do better than the U.S. at much lower cost doesn't say they do as well as they could if they spent more. Certainly the reports of waiting lists in the British NHS suggest that NHS is underfunded.]

      • IMASBA

        “What seems clear is that, assuming the continued expensiveness of medical technologies, as societies get richer they can and should spend an ever-expanding share of their wealth on medical care.”

        The absolute growth in medical spending should always be less than the absolute GDP growth because that growth cannot be maintained without additional infrastructure, education and ecological footprint reduction. Also, the people have the right to choose how they want to spend GDP growth: they may well decide they’d rather lower the retirement age, make education free or lower taxes instead of increasing healthcare spending, and all scenarios in between.

      • @RSDMad

        I would agree somewhat. Specialists who get paid 2-3 times what pediatricians and general med docs? Why? Specialists even work less hours. They should make maybe a 25-35% premium. Family prac docs should get paid more perhaps? Hospitals have very little sharing of information and then they spend tons on nice lobbies. That all costs money.

  • IMASBA

    I think there is something really , really important to remember here: how is “death by malpractice” defined? When a 95-year old with cancer dies when he is operated on and the medical personnel make the tiniest, and to be expected, “mistake” that wouldn’t have been a problem if the patient had not been a 95-year old with cancer, does this count as death by malpractice instead of death by cancer (or old age, but doctors never say old age kills someone, it’s always some symptom of old age that gets blamed, perhaps for bureaucratic reasons, leading people to mistakenly believe that finding a cure for that symptom would lead to significant life extension)? If the death of such a patient is generally ruled to be the result of malpractice then I’m not surprised at all that 1 in 6 Americans die because of “malpractice” and that fraction will only go up as we try to keep extending life more and more without actual fundamental anti-ageing technology.

  • Elijah Armstrong

    How many of these errors were due to affirmative action hires, do you think?

    • IMASBA

      Assuming they only hire people who completed a medical education I’d say 0…

      Seriously, the medical professions aren’t known for their high unemployment rate.

    • Shanika

      I have witnessed quite a few. In many institutions keeping the affirmative action professionals from killing people is like a second profession for better trained persons at all levels. Even nurses’ aides can tell the difference.

  • John_Maxwell_IV

    “the trigger tool doesn’t catch errors in which treatment should have been provided but wasn’t”

    If these are included in the estimate, I don’t think it’s quite far to use this estimate as evidence that medicine is counterproductive/harmful.

    • VV

      Really? What happened to expected lifespan in developed countries in the last 70 years?

      • Jayson Virissimo

        There are lots of things that reliably increase lifespan that are not kinds of medicine.

      • VV

        Yes, but they aren’t sufficient to explain the observed effect.

      • @RSDMad

        Good point. Countries that have less money now have access to quality care. They are providing it to more people than ever (what I observed India for example). If they end up walking more places like I observed in Thailand, they are indirectly getting more exercise than we do as well. Probably less processed food to boot. The fact that we are being passed up by every European country should make us take a closer look.

    • IMASBA

      The sampled population are mostly sick/injured and/or old people, many of which are in palliative care.

  • VV

    The numbers might be quite misleading. How many of these people who died of medical errors would have died anyway in a short time (weeks-months)?

    • http://overcomingbias.com RobinHanson

      That same bias can apply to lived saved by medicine, so this is still useful as a way to compare lives saved vs. lost via medicine.

      • Nancy Lebovitz

        I don’t think so. Do we have numbers for lives saved by medicine?

  • arch1

    Are there any ‘how to survive your trip to the hospital’ hints & tips lists being generated based on the results of these latest studies? It would be helpful to know some of the highest benefit/cost measures a prospective patient can take.

    • IMASBA

      Isn’t it obvious? Don’t be very old, sick or heavily injured when you enter the hospital.

      Also, pay for additional tests, second opinions and more experienced surgeons and then tell yourself some good bdtime stories to help you sleep at night since you are getting better care at the expense of people with less financial means.

    • Michael Wengler

      My sister rides hard herd on the doctors and staff who treat my parents whenever they go in. They completely consistently forget to order things they discuss with us, and staff completely consistently fails to implement orders on timescales that would seem to be important.

      If I had the money and knew about people like my sister, I would pay them to supervise my hospital stay.