Do Tens of Thousands of Americans Die from Medical Errors?
An Institute of Medicine report issued a couple years ago has been widely touted in the media as establishing that s many as 98,000 people may die every year from medical errors. But a follow-up study in the Journal of the American Medical Association suggests that those estimates are fraught with a number of problems that bring into question their reliability. The authors of the JAMA study suggest that deaths from medical errors are probably in the 5,000 to 15,000 range.
Believe it or not, a major point of contention is what exactly constitutes a medical error that causes the death of a patient. In the JAMA study by Rodney Hayward and Timothy Hofer, the two studied 4,198 patients who died at seven Veterans Administration medical centers from 1995 to 1996. They took a random sample and had 14 board-certified internists review the case history of 113 of those patients.
One of the major finds was that there was wide disagreement among those internists on whether or not a patient had died as a result of a medical error.
If one reviewer rated a death as definitely or probably preventable, the probability that the next reviewer would rate that case as definitely not preventable (18%) was actually slightly higher than the probability that the second reviewer would agree with the first (16%).
There are a number of possible explanations for this, including the inevitable disagreements over what qualifies as optimal treatment for given patients. As Hayward and Hofer noted, “These findings suggest that given enough reviewers, almost all active-care deaths would have some reviewers who believe that an error caused the death, but they would usually represent an outlier opinion.”
In other words, what Hayward and Hofer found is that in many of the cases, almost all of the internists would conclude that there was no error or that any errors didn’t cause the death of the patient, but there would be one or two internists who were essentially saying, “I could have saved that patient by doing something differently.” As they write,
Previously, most [studies] have framed ratings of preventable deaths as a phenomenon in which a small but palpable number of deaths have clear errors that are being reliably rated as causing death. Our results suggest that this view is incorrect — that if many reviewers evaluate charts for preventable deaths, in most cases some reviewers will strongly believe that death could have been avoided by different care; however, most of the “errors” identified in implicit chart review appear to represent outlier opinions in cases in which the median reviewer believed either that an error did not occur or that it had little or no effect on the outcome.
Excluding such outlier opinions and going with the consensus view, Hawyard and Hofer found that from 1.3 percent to 6 percent of the deaths could have been prevented, but that only 0.5 percent of all deaths were preventable and involved patients who would have survived more than 3 months with optimal care.
Sources:
Estimating hospital deaths due to medical errors: preventability is in the eye of the reviewer. Rodney A. Hayward, MD, and Timothy P. Hofer, MD, MS. The Journal of the American Medical Association, v.286, no.4.
Deaths from medical errors may have been overstated. National Center for Policy Analysis, July 25, 2001.
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