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- William W. Parmley, MD, FACC*
- ↵*Address for correspondence: William W. Parmley, MD, Editor-in-Chief, Journal of the American College of Cardiology, 415 Judah Street, San Francisco, California 94122
One of the most disturbing and provocative reports in recent years has been the tome prepared by the National Academy of Sciences, “To Err Is Human: Building a Safer Health System” (1). The report says that “Sizable numbers of Americans are harmed as a result of medical errors.” The numbers quoted in the study are indeed troublesome. It quotes from two large samples of hospital admissions from New York in 1984 and Colorado and Utah in 1992. The rates of adverse events caused by medical management were 3.7% and 2.9%, respectively. The preventable proportions of these errors were estimated to be 58% in New York and 53% in Colorado and Utah. These data were extrapolated to the 33.6 million admissions to U.S. hospitals in 1997 and implied that at least 44,000 and perhaps as many as 98,000 Americans die in hospitals each year as a result of medical errors. This would make this cause the eighth leading cause of death in the U.S.—ahead of motor vehicle accidents (43,458) and breast cancer (42,297).
Medication errors are a part of this problem. It is estimated that almost 2% of those admitted to the hospital experienced a preventable adverse drug event. These costs alone would total about $2 billion annually in increased hospital costs for the nation. Approximately 6,000 Americans die each year from workplace injuries; medication errors were estimated to cause 7,000 annual deaths. This included one of 131 outpatient deaths and one of 854 inpatient deaths.
When this report was first released in November of 1999, I remember thinking that these statistics could not possibly be correct. I have served for two years on our hospital committee, which reviews all deaths. I have been very impressed with the severity of illness of those who die in the hospital. They frequently linger in intensive care units and are sustained by extraordinary measures until they die. Sometimes the issue seems to be more “futility of care” than harm. In fact, over the two years, I can’t remember seeing a death that was caused by a medication or physician error. However, as I look back over my career, it is clear that all of us have seen some of these disturbing examples in our own hospitals. The relatively uncommon occurrence of errors causing death means that it would be difficult for any physician to judge the truth of the aforementioned numbers on the basis of their own anecdotal experience. I believe, therefore, that this is certainly a wakeup call to all of us as we review our Hippocratic admonition to “Do No Harm.”
The report suggests that Congress should create a center for patient safety in the Department of Health and Human Services. The purpose of the center would be to set safety goals, track progress, do research on prevention of mistakes and act as a clearinghouse for objective information on patient safety. The recommendations include the mandatory reporting of occurrences of “error”, but with some voluntary and confidential reporting. The report also suggests that accrediting and certifying organizations, licensing bodies and the Food and Drug Administration concentrate more on safety than they have in the past. All of this is intended to create a culture of safety for all parts of the health care enterprise. This report is the first in a series to be released through an Institute of Medicine initiative to improve the quality of health care in America. In the interest of full disclosure, the study was funded by the National Research Council and the Commonwealth Fund.
Whatever your perception of the numbers presented in this report, it is clear that we have a considerable problem that needs to be addressed. It also seems to me that it is unlikely to be solved by another government bureaucracy. The heightened perception of the problem provided by the Institute of Medicine report will help us to focus local efforts on the issues that may be most useful. If we are part of the problem, then we must also be part of the solution. We must take the admonition to “DO NO HARM” very seriously.
- American College of Cardiology
- ↵The National Academy of Sciences. To Err Is Human: Building a Safer Health System. 2000. http//www.nap.edu/open/book/0309068371.