Can Health Data Save Us From Medical Errors?
A recent BMJ report suggests that medical errors cause more than 250,000 deaths in the United States every year. Before the 250,000 number becomes a widely accepted fact, it warrants critical review of the BMJ report.
The study ranks medical error third behind heart disease (611,000) and cancer (585,000) as a leading cause of death in the United States and claims that deaths from medical errors are 7-8 times more common than gun-related deaths. Rather than relying on death certificate information, the authors call for improved tracking of medical-related deaths.
But where does the 250,000 number come from?
Taking a Closer Look
The BMJ paper pooled data from four prior studies, which reported medical-error deaths in diverse populations, ranging from 10 hospitals in North Carolina to the all Medicare hospitalizations from 2000-2002. Extrapolating estimates from these studies to the total number of 2013 hospital admissions in the United States, the study calculated a mean death rate from medical error of 251,454 per year.
The problems with the analysis include:
- Definition of a medical error,
- Distinguishing preventable from non-preventable adverse effects,
- Distinguishing adverse effects (complications) from errors,
- Assessing causality and
- Pooling data from different populations/subgroups and with differing assumptions.
A closer look at the studies used in the BMJ report raises serious questions about the validity of the 250,000 figure.
Lumping medical-error deaths with unpreventable adverse-effect related deaths only confuses the statistics. One study cited in the BMJ analysis counted 100 percent of adverse effects as potentially preventable and related to medical error.
As all experienced clinicians know, many adverse effects are not related to medical error and certainly not preventable. To count these scenarios as “errors” could seriously overestimate the number of deaths attributed to medical mistakes. Even attributing a death to a clearly recognizable medical error isn’t necessarily straightforward.
The Medicare study used in the pooled analysis included patients over 65 years of age, many of whom likely had multiple chronic conditions. A medication error for someone with more than one serious disease could be catastrophic. However, it’s also possible that many of such deaths were unrelated to the medical errors identified.
In sum, the BMJ number of 250,000 medical error related deaths is really a wild guess.
More Than Zero Is Too Many
While deaths by medical error may not total 250,000, any number is too high. Patients, caregivers and healthcare organizations need to share in the effort to reduce the risk through better definitions, data and prevention. We must improve electronic medical records and decision support, educate patients and involve all caregivers.
Engaging and empowering patients and their families, particularly in the hospital setting, to take charge of their care can be a first line of defense against some medical mistakes (e.g. medication allergies or even wrong site surgeries). Providing busy clinicians with state of the art technology and seamless points-of-care decision support is also likely to reduce risk of error.
Regarding EMR-related patient prescription errors, health tech and healthcare systems urgently need to address transitions of care from acute care in hospitals to home care. These are points of risk for miscommunication with potential for serious consequences. In a complex health system, including all caregivers in the “culture of safety” is essential to success.
As technology makes its way throughout the healthcare industry, the real message of the BMJ paper is the need for better data.