In 1999, the Institute of Medicine reported that medical errors in American hospitals cause up to 98,000 deaths and more than 1 million injuries each year. In response to the institute's report, hospitals in North Carolina and around the country announced initiatives to improve patient safety.
A recent article in The New England Journal of Medicine assessed the efficacy of these initiatives. Looking exclusively at hospitals in North Carolina, the article reported a shockingly high rate of preventable injuries to patients, and little or no improvement over time.
Year in, year out, medical mistakes in hospitals kill more North Carolinians than the combined toll of automobile accidents, breast cancer, manslaughter and murder. While we enact laws and mount public education campaigns to reduce the risk of auto accidents, invest millions to find a cure for cancer and mobilize the power of the state to prevent and punish violent crimes, little has been done to reduce the deadly toll of preventable medical errors.
Researchers from Harvard Medical School and the Institute for Healthcare Improvement analyzed a random sample of admissions at 10 randomly selected North Carolina hospitals from 2002 through 2007. A trained team identified suspected medically induced harms, which were then evaluated by independent physician reviewers.
The results were sobering:
Patients admitted to a North Carolina hospital had a 1 in 5 chance of being harmed by the medical care they received.
13.8 percent of the medically induced harms were extremely severe, causing a permanent or life-threatening injury, or death.
Most (63.1 percent) of the injuries were preventable.
Over the six years of the study, the researchers found no reduction in the rate of severe injuries.
In the sample of 2,341 patient records, the reviewers identified 14 cases in which the medical care caused or contributed to the patient's death and classified nine of those deaths as preventable. In addition, the reviewers identified 13 cases in which the patient suffered a preventable permanent injury.
These data confirm the staggering toll of medical errors in North Carolina hospitals. The American Hospital Association reports 1,041,918 admissions to nonfederal community hospitals in North Carolina in 2008. Based on the preventable death rate and preventable permanent injury rate in the New England Journal article, approximately 4,000 patients die and 5,700 patients are permanently injured every year in North Carolina hospitals because of preventable medical errors.
Proven safety measures, as noted in the article, will save lives:
Many preventable injuries in hospitals are caused by a lack of communication among the patient's multiple health care providers, who continue to depend on hand-written notes and orders, placed in a bulky physical chart. Despite the proven efficacy of electronic record keeping in improving communication and reducing mistakes, less than 10 percent of hospitals have even basic electronic record keeping in place.
In a short-sighted effort to cut costs, hospitals have slashed their nursing staffs to the bone. As the Journal article notes, medical residents and nurses routinely work hours in excess of those proven to be safe. Hospitals must stop short-staffing and end the practice of relying on marathon shifts by exhausted doctors and nurses.
The rate of hospital-caused infections remains high for reasons that are unacceptable. Compliance with simple interventions such as hand washing is poor in many centers.
While thousands die because of medical errors, some hospitals - and their insurance carriers - want to change the law and limit the rights of injured patients to take legal action. That effort is profoundly misguided. Relieving hospitals of responsibility for their mistakes will only increase the risk of harm to patients.
Hospitals will not solve these problems on their own. Improving patient safety requires a concerted campaign. With so many lives at stake, it is high time for health care providers, accreditation agencies and patient advocates to join forces to reduce the number of medical errors.
James Bryan, M.D., has taught and practiced internal medicine at UNC Medical School since 1964. Burton Craige is an attorney in Raleigh.
