Three recent reports have estimated that more than 200,000 patients die in U.S. hospitals each year because of preventable medical errors, according to an article in the March issue of the Journal of Patient Safety. The U.S. health care system can and must implement effective strategies to reduce such deaths, say lead author Dr. Kevin T. Kavanagh and his colleagues.
Kavanagh remarked: “Our utmost concern is that—despite having the knowledge to prevent adverse events—many health systems do not adequately invest in patient safety to put well-known safety-improvement strategies in place.”
The authors add their perspective as patient advocates to the ongoing debate regarding the number of in-hospital deaths that occur because of medical errors. These deaths encompass a wide range of preventable causes, such as bed ulcers, hospital-acquired infections, embolism, surgical errors, and misdiagnosis.
In response to the recently reported figures, some in the health care industry have pointed out shortcomings of the measures used in those analyses. The critics have cited the difficulty of proving a specific cause of death; others argue that many causes can be traced back to a patient’s lifestyle choices, and many patients are near death at the time of the incident. But Kavanagh and his coauthors write: “Even if the unintended event only shortens life by a few days, it does not mitigate the severity of the event.”
Kavanagh added: “As a whole, concerns with data are unfounded since the data tend to underestimate, not overestimate, the number of preventable deaths. In addition, the context of the patient is irrelevant and must be dissociated from medical error.”
Other studies have reported lower estimates. One analysis, which extrapolated data from the United Kingdom’s National Health Service, estimated that 25,000 preventable deaths occur in U.S. hospitals per year. Kavanagh and colleagues reply: “Using studies derived from countries with an integrated nationalized health care system to estimate the quality of the U.S. health care system is not valid, since the United States has a fragmented system with little centralized or national control.”
All agree that better-quality data are needed. Meanwhile, evidence suggests that the currently available data—based on “voluntary and nonaudited reporting mechanisms”—likely underestimate the true rate of preventable events. Kavanagh and others in the patient safety movement cite the example of the National Transportation Safety Board, which investigates aircraft accidents.
“The United States health care system as a whole can substantially decrease the incidence of adverse events and associated deaths,” Kavanagh and his coauthors write. They note that there are known solutions to reduce the risk of adverse events—particularly, investment in adequate nursing levels and a “culture of safety.”
Performing a critical analysis on the available data, the authors estimated that hospital-related preventable mortality was approximately 200,000 deaths per year. While acknowledging that the data are imperfect, they write: “The onus should not be on consumers but on the health care industry to generate comprehensive data to demonstrate that their product is safe.” The authors note that, even if the low estimate of 25,000 were correct, that would amount to approximately five potentially preventable deaths per year per U.S. hospital.
“In what other industry would such a record be tolerated, let alone defended?” Kavanagh and his coauthors ask. “Would the airline industry and public ever tolerate even a single preventable airline crash? We can and must do better.”