Hospital errors in U.S. continue despite efforts: Study

By Dr. Ananya Mandal, MDNov 25 2010

A new study published Thursday in the New England Journal of Medicine (NEJM) showed that all the efforts to make American hospitals error free and safe are inadequate.

The study by a team of researchers, led by Christopher Landrigan of Boston’s Brigham and Women’s Hospital looked at 2,300 patient admissions records from 10 North Carolina hospitals selected at random. They found that in 588 cases, patients were somehow harmed as a result of medical procedures, medications, or other related causes. Landrigan and his colleagues wrote, “Of 588 harms that were identified, 245 (41.7%) were temporary harms requiring intervention… and 251 (42.7%) were temporary harms requiring initial or prolonged hospitalization… An additional 17 harms (2.9%) were permanent, 50 (8.5%) were life-threatening, and 14 (2.4%) caused or contributed to a patient’s death.” A whopping 63 percent of the incidents were avoidable.

Landrigan maintains that, “These harms are still very common, and there’s no evidence that they’re improving… The problem is that the methods that have been best proven to improve care have not been implemented across the nation.” Some suggested remedies included computerizing patient information and prescription records, limiting the number of consecutive hours that nurses spend on the job, and implementing checklists for surgical operations and other medical procedures.

The common errors were;

• Procedural errors (186 cases)
• Medication-related problems (162 cases)
• Hospital-acquired nosocomial infections (87 cases)
• Others like flawed diagnostic evaluations and even falls

The authors write that there is “little evidence that the rate of harm had decreased substantially” from 2001 to 2007. They added that their findings “validate concern raised by patient-safety experts in the United States and Europe that harm resulting from medical care remains very common.” They find the results “disappointing” but “not entirely surprising… Despite substantial resource allocation and efforts to draw attention to the patient-safety epidemic on the part of government agencies, health care regulators, and private organizations, the penetration of evidence-based safety practices has been quite modest.”

The report focused solely on health care facilities in the North Carolina area but according to Landrigan it was “unlikely that other regions of the country have fared better.”

An expert on hospital safety who was not associated with the study said the findings were a warning for the patient-safety movement. “We need to do more, and to do it more quickly,” said the expert, Dr. Robert M. Wachter, the chief of hospital medicine at the University of California, San Francisco. Similar results were seen in a recent report from the government. The report showed that in October 2008, 13.5 percent of Medicare beneficiaries — 134,000 patients — experienced “adverse events” during hospital stays.

Like Landrigan, Dr. Jeffrey Rothschild of Brigham and Women’s Hospital in Boston believes patient safety has likely improved since the study concluded three years ago. “But lots of opportunities for improvement are still out there…One of the challenges is gaining a really good handle on the extent of the problem,” said Rothschild, also an assistant professor of medicine at Harvard Medical School.

The research was funded by a grant from the Rx Foundation and by funds from the Institute for Healthcare Improvement.