According to latest findings, medical errors do not happen at hospitals alone. They are also seen in the doctor's offices as well. The study reporters note that about half of U.S. malpractice payments - a proxy for medical errors - from 2009 involved patients seen outside of the hospital.
There have been earlier studies that have focused mostly on the situation inside hospitals, some of which now have checklists and other systems in place to help prevent major medical mistakes. But “invasive and high-technology diagnostic and therapeutic procedures are increasingly being performed in the outpatient setting,” the researchers note, so they decided to compare the number and seriousness of adverse events in inpatient and outpatient settings, as reflected by malpractice claims.
A 1999 report from the Institute of Medicine showed nearly 98,000 deaths from preventable medical errors every year. That the number of malpractice claims would be virtually the same for hospitals and doctors' offices was unexpected, Dr. Tara Bishop, who worked on the study, said. Dr. Bishop from Weill Cornell Medical College in New York said, “We were actually very surprised by that finding. I hope it's a wake-up call for the medical community and for patients, so we can start working on ways to solve these problems.”
Using the U.S. National Practitioner Data Bank, researchers at Weill Cornell Medical College compared malpractice claims paid on behalf of physicians who work in hospitals or doctors' offices. The investigators identified 10,739 paid malpractice claims in 2009, including 4,910 claims for inpatient, 4,448 claims for outpatient, and 966 claims for both settings. A small but, significant increase in the proportion of payments in the outpatient setting was seen from 2005 to 2009 (41.7 to 43.1 percent). The most common reason for a paid claim was diagnostic (45.9 percent) in outpatient setting and surgical (34.1 percent) in the inpatient setting. Both settings had major injury and death as the two most common outcomes. Average payments made were significantly higher in the inpatient setting as compared to outpatient ($362,965 versus $290,111).
“We found that the number of paid malpractice claims in each setting is similar and that the average payment amount, although higher in the inpatient setting, was approximately $300,000 in the outpatient setting,” the authors write.
Bishop explained, “These weren't trivial errors - death and major injuries were the most common reason for malpractice claims. It's nice to see this trend coming down, but we still don't know if it's due to better patient safety.”
The report published in the Journal of the American Medical Association says there are 30 times as many outpatient visits as hospital discharges every year.
Bishop said the most common errors were different across the two settings, with surgical mistakes dominating the claims for hospitalized patients and misdiagnosis being the biggest problem at the doctor's office.
In an accompanying editorial, Dr. Gianna Zuccotti and Dr. Luke Sato of the Harvard Medical Institutions in Boston say malpractice claims represent only the tip of the iceberg for medical errors. They note that the decrease in claim payments over the study period - by more than 2,500 - is good news. The bad news, they add, is that rigorous, effective programs for controlling the risk of errors outside the hospital don't exist right now.
Bishop added patients can also help lower the chance that their doctor will make a mistake by learning about the tests and medications they get, and keeping their doctor up to speed about what's happened between visits. “I do hope that patients will realize that it's important to take control of what happens in their healthcare,” Bishop said.
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