Medical Error: The 3rd Leading Cause of Death
Most people in the U.S. die of heart disease. There has been a significant reduction in deaths due to heart disease in recent years. The second leading cause of death is cancer. As indicated in Bailar and Gornik’s paper below, there has been no significant reduction in deaths due to cancer in recent years. The third leading cause of death is medical error and that has most likely increased in recent years.
It was well known in 1975 when I joined the faculty of the University of Colorado School of Medicine that the risk of accidental death increased 10-fold upon signing in to a hospital. That risk is probably higher today because people are sicker, many more drugs are given, and an increasing number of antibiotic-resistant hospital induced infections cause an estimated 80,000 deaths per year (JAMA, July 26, 2000, p 483).
A wise person would avoid hospital admission unless they have a condition where the risk of dying outside of the hospital is significant. When it is necessary to be in the hospital it is wise to have a loved one present at all times to monitor proceedings, or to hire a healthcare professional to help oversee care.
In a Johns Hopkins study, Starfield reported that medical error is the third leading cause of death in the U.S. with an estimated 225,000 deaths/year and medication errors are the largest component of these deaths. An estimated 7000 deaths/year occur from medication errors in hospitals and 106,000 deaths/year occur from adverse drug events (ADEs). Bates et. al. reported that 42% of serious ADEs were preventable and that errors resulting in preventable ADEs occurred most often at the stages of ordering (56%) and administration (34%); transcription (6%) and dispensing errors (4%) were less common. Errors were much more likely to be intercepted if the error occurred earlier in the process: 48% at the ordering stage vs 0% at the administration stage. Leape showed that dosage errors, in particular, were primarily due to the physician’s lack of knowledge about the drug or about the patient for whom it was prescribed.
Studies have shown that automating drug orders and administration reduce errors by 60-100% depending on type of medication error and that preventable ADEs cost $4685 and increase length of hospital stay by 4.6 days on the average. Automation of order entry and drug administration may be the fastest and cheapest way to reduce medical error and savings will typically more than pay for cost of automation.
Eldar provides an excellent recent review of the worldwide literature on medical error in an unlikely source, the Croatian Medical Journal. The author notes that in the 1995 Australian study found adverse events in 16.6% of 14,179 admissions vs. 3.7% in a 1984 Harvard study. However, 2/3 of the adverse events were omission, rather than commission. Perhaps this explains the discrepancy. Almost 50% of the errors were caused by surgery and only 20% by medication errors. Of the later 20%, ordering caused 56% and medication administration caused 24%. Careful observation in a teaching hospital in Israel indicated an average of 1.7 errors per day per patient was the norm. This has been my personal experience in a Boston hospital.
While the National Institute of Medicine has declared this a national emergency, I am constantly amazed in discussions with intelligent and highly educated people, that they find it impossible to grasp the seriousness of the problem. Their consciousness reinterprets the data to mean that sick people who are probably close to death anyway are just dying. This is not the case as these are unnecessary deaths that are largely preventable and they occur in healthy young people as well as older sick people.
“There is a growing conviction in all hospitals, even in those which are best conducted, there is a great and unnecessary waste of life. “ Florence Nightingale, 1859