Posts Tagged ‘medical errors’

Having A Medical Test?

Posted by medconsumers on September 1, 2008

Ask Questions and Don’t Forget to Get the Results

Numerous mistakes are made all along the way once the primary care doctor orders a test, according to a new survey of eight family medicine practices. The wrong test is ordered; the test is incorrectly administered; incomplete results are conveyed to the doctor; and the results are not reported to the patient. These are a few of the errors reported in this survey that allowed 243 doctors and their staff to report their experiences anonymously.

The research team, led by J. Hickner of the University of Chicago Pritzker School of Medicine, set out to learn the most common testing errors and how often they harm patients There was no attempt to determine the total incidence of testing errors.

The findings were published in the journal Quality and Safety in Health Care. Either not ordering a test or ordering the wrong test accounted for nearly 13% of the errors reported in the survey. In about 18% of the reported errors, the correct test was ordered but not administered properly. The most common type of error (25%) involved delays in getting results from the lab, especially in practices that use a high number of different labs and in practices that have poor follow-up systems.

Patients were unharmed by 54% of errors, but 18% did result in harm. Worse, “harm status” was unknown for 28%. “Minority patients were more likely than white, non-Hispanic patients to suffer adverse consequences or harm,” wrote Hickner and colleagues.

Bottom Line:

Always ask what the test is for and its estimated rate of accuracy. Don’t assume that “no news is good news.” Always call for an explanation of your test results. Better yet, request a copy for your files.

Maryann Napoli, Center for Medical Consumers ©
September 2008

Posted in Screening | Tagged: medical errors, Screening | Comments Off

Assessing Physician Performance

Posted by medconsumers on December 1, 2006

Despite the fact that seven years have passed since the Institute of Medicine’s landmark report on the epidemic of medical mistakes plaguing U.S. hospitals, experts continue to decry the lack of substantial progress in reducing substandard doctor performance. According to one renowned safety expert and co-author of the errors report, Lucian Leape, MD, Harvard School of Public Health, “Performance failures of one type or another are not uncommon among physicians, posing substantial threats to patient welfare and safety.”

In the Annals of Internal Medicine earlier this year, Dr. Leape estimated, “At least one third of all physicians will experience, at some time in their career, a period during which they have a condition that impairs their ability to practice medicine safely.” If that’s not frightening enough, he also warns that hospitals fail to routinely monitor physician performance and identify these problem doctors.

Unfortunately, hospital credentialing has largely been ineffective in making patients safer. A major problem, according to Leape, is that “Independence is so highly valued that physicians are loath to evaluate or confront a colleague who they perceive is having a problem.” Hospitals are not rushing to confront problem doctors either. Doctors denied admitting privileges or facing limitations in their hospital practice often drag the offending institution into court seeking to appeal the credentialing decision or be paid monetary damages.

A hospital’s inherent economic conflict of interest may also get in the way of disciplining a problem doctor if she or he admits many patients and contributes positively to the facility’s bottom line. Hospitals have a fiduciary as well as ethical responsibility to do everything possible to protect patients from preventable harm. Their continued failure to weed out substandard doctors violates that responsibility.

Simulation Technology
What to do? To improve the credentialing process, hospitals should be required to use simulation technology to routinely evaluate the performance of every doctor on staff so as to make better credentialing decisions. Pilots are trained to fly in flight simulators, which provide an exact replica of an airline’s cockpit. Physicians could be similarly trained, for example, to insert a breathing tube on a life-size dummy which would “breathe, bleed, and express pain” as a sick person would under real-life circumstances.

It makes sense to employ simulation technology train people who will perform risky tasks in order to evaluate the safety of their job performance, including unanticipated emergencies. As it stands now, unsuspecting hospitalized patients often become training fodder with their safety possibly compromised.

Pilots, as a condition of licensure, are required once or twice a year to go to a flight simulation center for an evaluation of their abilities. By contrast, doctors are licensed in virtual perpetuity and are not required to routinely demonstrate their competence.

Although relatively new to health care, simulation technology could do for hospitals and patient safety what it has done for pilots and the safety of flying – provide a way to both train and routinely evaluate a doctor’s competency, weed out substandard performers, and keep the public out of harm’s way in the process. But until that happens, a doctor’s hospital affiliation, no matter how prestigious, does little to assure a patient’s safety.

Arthur A. Levin, MPH, Center for Medical Consumers ©
December 2006

Posted in hospitals | Tagged: hospitals, medical errors, physicians | Comments Off

Hospital Errors Still Out of Control

Posted by medconsumers on August 1, 2006

Every day patients spend in a hospital bed, they risk harm from at least one preventable medication error. This disturbing finding is cited in a recent report on medication errors undertaken by the Institute of Medicine (IOM) at the behest of Congress. While many such errors cause only minor problems, a significant number result in permanent injury or death.

The IOM estimates that a total of 1.5 million preventable injuries occur each year as a result of lapses in medication safety. Almost half of these befall residents of nursing homes or other long-term care facilities, about 400,000 afflict hospital patients, and the rest occur in outpatient settings. Injuries to hospital patients alone are said by IOM to generate $3.5 billion in extra medical costs. Given that many drug-related injuries go undetected and/or unreported, the report concedes that the estimate of 1.5 million injuries is likely too low.

While listening to the press conference announcing the report’s release last month, I was reminded of Yogi Berra’s famous line—“it’s like déjà vu all over again.” As a co-author of the 1999 IOM report on medical errors, “To Err is Human,” I found that much of what this latest report had to say was not new. In fact, I became angry at what I was hearing during the press conference—namely that preventable medication errors were still out of control, despite the urgent warnings we had sounded six years earlier.

The 1999 report concluded, “…there is reasonable agreement about useful approaches” to prevent medication errors. Six years ago we thought that our recommendations for tackling the prevention of medication related errors would be put into practice relatively quickly. In fact the 1996 report challenged the health care system to reduce all varieties of medical mistakes by 50% within five years. But while stories of individual efforts to improve medication safety may abound, the new IOM report suggests that systemwide, the risks remain serious and widespread.

The 1999 report recommended use of computers to prescribe and dispense medicines in all hospitals. The new report recommends that medication prescribing and dispensing should be done electronically by 2010 in all settings, yet, at most, one out of five hospitals and a much smaller proportion of clinics and doctor’s offices now have that capability.

The new report’s number one recommendation for safer prescribing, dispensing and use of medications is that health care providers engage consumers in “activities and behaviors that promote their health, well-being and safety.” More specifically, it recommends that patients become better informed, ask more questions about their medications and keep an up-to-date list of the drugs they take. (For more: www.iom.edu/CMS/3809/22526/35939/35945.aspx)

Similar advice has been handed out to consumers for at least several decades, but considering the continuing epidemic of medication error-related harm detailed by IOM, I question how effective this has been has been as a prevention strategy.

I don’t disagree that becoming your own first line of defense makes good common sense, given the high risk of being hurt due to the slow pace of safety improvements in prescribing and dispensing edications. But I worry that placing too much responsibility for error prevention on patients excuses providers from accountability for the safety of care they render. We don’t approach airline safety by advising passengers to inspect the airplane for air worthiness before they board or to bring a list of questions to ask pilots about their flight plan – passengers expect flying to be safe. I suggest that medication users should someday have the same expectation—that medication use is safe—and we should hold providers accountable for meeting that standard.

For now, the best advice I can give readers is to favor health care providers who demonstrate they are serious about improving medication safety. Ask if a hospital is using computerized physician order entry; ask whether an outpatient clinic or doctor’s office can electronically prescribe and transmit prescriptions; and ask whether a pharmacy can receive electronically transmitted prescriptions from your health care provider.

Arthur A. Levin, MPH, Center for Medical Consumers ©
August 2006

Posted in hospitals | Tagged: hospitals, medical errors, prevention | Comments Off

Empty Promises

Posted by medconsumers on December 31, 2005

The Failure of the New York State Health Department to Monitor Medical Errors / New York State’s Failure to Adequately Protect Patients
By: Blair Horner, Arthur Levin. MPH, Rachel Marx

Endorsed by: Center for Justice & Democracy, Center for Medical Consumers, New York Public Interest Research Group, New York StateWide Senior Action Council, Patient Information Alliance, PULSE of New York

It has been a little over five years since the release of the National
Academy of Sciences’ Institute of Medicine’s (IoM) landmark report, To Err is Human. Authored by a prestigious group of national experts in patient safety and quality improvement, the report documented for the first time the staggering number of medical errors occurring in the nation’s hospitals. The IoM estimated that between 44,000 and 98,000 patients die each year in U.S. hospitals as a result of medical errors, many of which are preventable. The report also stated that the nation spends as much as $29 billion in treating those injured by medical mistakes.

Read entire report.

Posted in Advocacy | Tagged: Advocacy, medical errors | Comments Off

How Prevalent are Medical Errors?

Posted by medconsumers on April 1, 2003

People Frequently Injured by Medical Errors
By Arthur A. Levin, MPH

It has been two and one-half years since the Institute of Medicine (IOM) issued its groundbreaking report on medical errors. Having been part of the IOM effort, I had high hopes that it would finally force the health care system to confront the crisis in patient safety with a sense of urgency. But as the months go by, I become less and less convinced that a sufficient number of doctors and hospitals are committed to doing whatever is necessary to stem the tide of death due to medical mistakes. Instead, some have chosen to focus on debunking the IOM’s calculations as unscientific and grossly exaggerated, thus denying the problem exists rather than fixing it.

The IOM concluded that between 44,000 and 98,000 hospitalized patients suffer a fatal injury because of medical errors each year. It has responded to its critics by pointing out that this is likely an underestimate of the true dimensions of patient injury for several reasons. First, the IOM’s estimate is based on errors only in hospital care. In other words, the type of care that is rapidly shifting into ambulatory settings; and second, medical mistakes are well known to go unrecognized and undocumented in hospital medical records.

Until now, there has been little evidence of the risks patients face from medical errors occurring outside of hospitals. But, two recent studies appear to support IOM’s view that the 44,000 to 98,000 range is likely an underestimate. Alan J. Forster, MD, and colleagues from the University of Ottawa and Harvard Medical School interviewed 400 patients discharged from a large unnamed teaching hospital and reviewed their medical records. One out of five were found to have suffered an “adverse event” after leaving the hospital (Annals of Internal Medicine, 2/4/03). An adverse event was defined as a treatment-related injury rather than one due to the underlying medical condition. Two thirds of all reported injuries in this study were due to drug errors and a majority was judged preventable.

The researchers point out that their study is probably biased towards underestimating risk because “The sicker patients …too ill to speak on the phone for 20 minutes, readmitted to the hospital, or [who] had died either declined or were incapable of responding.”

In a second study, Jerry Gurwitz MD, University of Massachusetts Medical School, and colleagues, reviewed the experiences of 27,000 seniors enrolled in a Medicare HMO. (JAMA 3/3/03) Over the course of a year, the researchers identified 1,523 adverse drug events, a third of which were judged “serious, life threatening or fatal” and two out of five were the result of preventable errors. In an accompanying editorial, David Classen, MD, points out that extrapolation from of the study’s findings would suggest that as many as 180,000 life-threatening or fatal adverse drug events may occur in the Medicare population each year.

Even consumers may be ignoring the risks they face in their encounters with doctors and hospitals. Robert J. Blendon, ScD, Harvard School of Public Health and colleagues, conducted a study of 1,207 people, including 831 doctors, to find out their attitudes about medical errors. (New England Journal of Medicine, 12/12/02) Four out of ten consumers surveyed reported an error in their own care or that of a family member-almost half of which were serious or fatal. Yet, when asked to choose whether 500, 5,000, 50,000, 100,000 or 500,000 deaths came closest to the actual number of patients fatally injured each year in U.S. hospitals, a majority chose 5,000, far below the IOM estimate and incongruous with their own experience. Coincidentally, 5,000 was also the figure picked by the majority of doctors surveyed.

That consumers underestimate the potentially deadly consequences of error may explain why, despite the mounting evidence of harm, there is so little public outcry over the lack of substantial progress in making health care safer. The current slow pace of change is costly-tens of thousand of lives have been lost since the IOM first issued its report. Many of these lives could have been saved by faster and more decisive action. In the meantime, kept in the dark about the safety records of doctors and hospitals, consumers are left to navigate on their own and to hope they have made the right choice.

(April 2003)

Posted in Advocacy, hospitals | Tagged: hospitals, injury, medical errors | Comments Off

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