Medical Errors Stay Stubbornly At Same Levels, Despite Intensive Efforts

The number of medical errors and unavoidable mistakes, termed patient harms, have not gone down over a six-year period in the USA, despite serious efforts to improve things, researchers from Harvard Medical School reported in NEJM (New England Journal of Medicine) after examining six-years' worth of medical records at 10 North Carolina Hospitals.

Teams of nurse reviewers looked at the medical records of over 2,341 hospital admissions spanning from the start of 2002 through to the end of 2007, they were all selected randomly. 588 examples of patient harm were found, including surgical errors, dosage mistakes, and hospital-acquired infections - that is a patient injury rate of 25.1 per 100 admissions.

The authors wrote:

"Though disappointing, the absence of apparent improvement is not entirely surprising."

84.4% of patient harms were short lived and not serious, except for 50 which were classed as life-threatening. 14 of the patients died and 17 had problems which became permanent.

The investigators said they had chosen North Carolina because of its excellent history and commitment to patient safety. They added that their findings most probably reflect what has been occurring around the country.

The Institute of Medicine (IoM) published a critical report on error rates in 1999, prompting hospitals to try to do something about it. Dr. Christopher Landrigan, study author, wrote that no standardized guidelines that might help clinics and medical centers approach safety improvements exist.

The researchers found that the penetration of evidence-based safety practices has been fairly modest - apparently, only 1.5% of American hospitals have implemented a comprehensive system of electronic medical records.

Landrigan said:

"What has been done right is that regulatory agencies have begun prioritizing patient safety. But these efforts have largely been a patchwork of unconnected efforts and so far have not been as strong as they can be."

63.1% of all the medical errors could have been avoided, the authors wrote. The researchers looked at patient records and charts and identified several events that could have triggered a medical error incident:

• Result of a procedure - 186 injuries
• Medication errors - 162 cases
• Nosocomial (acquired in hospital) infections - 87 cases
• Other therapies - 59 cases
• Diagnostic evaluations - 7 cases
• Falls - 5 cases

The authors concluded:

"In a study of 10 North Carolina hospitals, we found that harms remain common, with little evidence of widespread improvement. Further efforts are needed to translate effective safety interventions into routine practice and to monitor health care safety over time."

"Temporal Trends in Rates of Patient Harm Resulting from Medical Care"
Christopher P. Landrigan, M.D., M.P.H., Gareth J. Parry, Ph.D., Catherine B. Bones, M.S.W., Andrew D. Hackbarth, M.Phil., Donald A. Goldmann, M.D., and Paul J. Sharek, M.D., M.P.H.
N Engl J Med 2010; 363:2124-2134November 25, 2010

Written by Christian Nordqvist