Are adverse errors in medicine an order of magnitude more common than current estimates?

This is startling news from Healthaffairs.org ! If the methodology is sound and it pans out, I think the underwriting and risk management for hospitals will have to adjust mightily, and in short order:

The patient safety study, conducted by David Classen of the University of Utah and coauthors at the Institute for Healthcare Improvement, compared three methods for detecting adverse events in hospitalized patients, including the Institute’s own Global Trigger Tool. The study drew on comparable samples of patients from three leading hospitals that had undertaken quality and safety improvement efforts.

Among the 795 patient records reviewed, voluntary reporting detected four events, the Agency for Healthcare Research and Quality (AHRQ) Indicators detected 35, and the Global Trigger Tool detected 354 events, ten times more than the AHRQ method.  In other words, the AHRQ indicators and voluntary reporting missed more than 90 percent of adverse events identified by the Global Trigger Tool.  If anything, the researchers say, their findings are conservative, because they rely on medical record review, which would not detect as many adverse events as direct, real-time observation would.

The researchers say that reliance on voluntary hospital reporting or the AHRQ indicators could lead to seriously flawed perceptions of patient safety in the United States.  They also note that the Global Trigger Tool detected a much higher rate of adverse events for hospitalized patients than previous studies have shown.  Although the Global Trigger Tool is a somewhat more resource-intensive method because it involves medical record review, the researchers suggest that it could be incorporated into commercial electronic health record systems, thus making it easier and less costly to use.

More disturbing perspectives that should keep you eating your apple a day:

An analysis by Jill Van Den Bos and colleagues at Milliman’s Denver Health practice in Colorado, based on insurance claims, estimated the annual cost of measurable preventable medical errors that harm patients to be $17.1 billion in 2008 dollars.  Ten types of errors accounted for more than two-thirds of the total cost, with the most common ones being pressure ulcers, postoperative infections, and persistent back pain following back surgery.  The researchers recommend that these three types of errors receive top priority for intervention and improvement.

John Goodman of the National Center for Policy Analysis, and coauthors, found that there is a social cost to adverse events, and it is based on what people would be willing to pay to avoid the risk of death or injury caused by medical management.  That dollar figure ranges from $393 billion to $958 billion.  Yet the United States has few policies to compensate patients harmed by medical errors, other than a “very imperfect tort system,” in which fewer than 2 percent of patients harmed ever file a malpractice suit and even fewer receive any compensation, the researchers note.

 

 

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