Hospital errors affect 1:3 patients

How common are hospital errors?

A shocking new study suggests that the number of “adverse events” befalling patients in U.S. hospitals may be 10 times higher than previous estimates.

If the authors are correct, this would mean that medical mistakes affect one in three people hospitalized  in the US. The study, published in the journal Health Affairs involved a review of almost 800 patient charts at three U.S. hospitals. Using a review technique known as the “global trigger tool,”  researchers detected a whopping 354 adverse events. Scarier still,  that figure might actually understate the enormity of the problem as it was based on potentially incomplete medical records rather than on direct observation in real time.

Dr. David C. Classen of the University of Utah believes his study gives a more reliable tally of hospital errors than other studies, including a 1999 landmark study from the Institute of Medicine entitled To Err is Human showing that hospital errors caused up to 98,000 Americans each year.

So what sorts of events were uncovered in the new review? According to Classen, there were three big ones:

• Medication errors, including getting the wrong drug the wrong dose of the right drug
• Surgical errors, such as having an operation done on the wrong site or gaffes that result in bleeding or infection;
• Hospital-acquired infections

The question many are now asking: is the new estimate accurate?

“It is hard to know that to make of the trigger tool,” admits Dr. Peter J. Pronovost, a Professor in the Johns Hopkins University School of Medicine (Departments of Anesthesiology and Critical Care Medicine, and Surgery) and Medical Director for the Center for Innovation in Quality Patient Care.

However, “Far too many patients suffer preventable harm in the U.S.” he added.

Other recent studies appear to confirm Classen’s findings.

Earlier this month the US government released data for the first time, showing how often patients are injured by certain medical errors in hospitals.  However, only eight types of serious, preventable errors were included in the comparison.

They were: air in the bloodstream, falls, bedsores, transfusions with the wrong blood type, urinary tract infections, blood infections, uncontrolled blood-sugar levels and foreign objects left in the body after surgery.

Other serious events, including wrong-site surgeries and medication errors, were not included.

And late last year, the Office of Inspector General for the U.S. Department of Health and Human Services said 180,000 Medicare recipients die each year from hospital mistakes. That’s more people than are killed every year in car crashes, or from diabetes or pneumonia.

Without doubt, health care has improved over the past decade, but it’s clear that there is still a great deal of work to do in order to achieve a health care system that safe, effective, patient-centered, efficient, timely, and devoid of disparities based on race or ethnicity.

Until then, SRxA’s Word on Health advises that if you think something is amiss or wrong with your hospital care, speak up.

The Great Vitamin D Debate

Over the past decade there has been a lot of conflicting advice about the benefits of vitamin D and calcium.

Like many of our readers, this confusion has left us pondering: How much milk should we be drinking?  Are supplements really necessary? Can we get all the vitamin D we need from the sun?

We were therefore very interested to read the results of The Institute of Medicine’s (IOM) recently released review on dietary reference intakes for the vitamin D and calcium. Their latest recommendations were based on a review of more than 1,000 studies and reports as well as testimony from scientists and stakeholders. Interestingly, the IOM looked at a range of health outcomes, far beyond bone health.  These included, but were not limited to, cancer, cardiovascular disease, hypertension, diabetes, metabolic syndrome, falls, immune response, neuropsychological functioning, physi­cal performance, preeclampsia, and reproductive outcomes.

Although they acknowledged that both are important for health, overall, the committee concluded that the majority of Americans are receiving adequate amounts of both calcium and vita­min D.

Perhaps more interestingly, they warned that more than 2,000 mg of calcium per day increases the risk of kidney stones. Likewise, very high levels of vitamin D (above 10,000 IU per day) are known to cause kidney and tissue damage.

So at the risk of upsetting the vitamin industry, we’ve decided to save our money and our kidneys. From now on we’ll be getting our daily requirements of calcium and vitamin D by drinking milkshakes in the sun!

Kiss and Tell?

About 300 years ago, the English author Alexander Pope famously wrote “To err is human, to forgive is divine.”

New research from the University of Illinois, Chicago concurs.  According to a study published in the November issue of Medical Care, people who believe their doctor or hospital would inform them if a medical error occurred are far more forgiving than those who doubt their health care provider would disclose the error.

A medical error is defined as a preventable adverse effect of care, whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete  diagnosis or treatment of a disease, injury or other ailment. Medical errors are one of the nation’s leading causes of death and injury and cost the US approximately $10 billion annually.  The Institute of Medicine estimates that as many as 300,000 patients are victims of medical errors, of which maybe as many as 200,000 people die.

In the new study, researchers surveyed a representative sample of Illinois residents regarding medical errors. About 40% of participants either had personal experience with medical errors, or had a close friend or family member who had been affected by an error.

Based on a hypothetical scenario, just 10% of survey respondents believed their physicians would be “very likely” to tell them if a medical error occurred. Yet, only a quarter said they would file a medical malpractice lawsuit if they were told about a medical error.

Respondents who trusted their doctor to disclose medical errors were no more (or less) likely to say they would sue. This was so even in a scenario where the health care provider offered to correct the problem through free additional medical treatment, and possibly a financial settlement.

However, people who trusted their health care provider to inform them about the error were more forgiving. Of the respondents who were most confident that their doctor or hospital would disclose the error, more than 60 percent said they would still recommend the provider, despite the error.

In contrast, only 30% of those who were skeptical about disclosure would continue to recommend the doctor or hospital.

The researchers found that although disclosure of medical errors is strongly preferred by patients, the most common policy is to “deny and defend” when errors occur because providers fear that it will trigger lawsuits and jeopardize their reputation.

The results show that patients perceived beliefs have a significant impact on their behavior. Patients who trust their providers to disclose errors may be no less likely to sue, but appear more likely to forgive. Conversely, patients who are most skeptical about disclosure may view their health care provider with “suspicion and frustration.”

Clearly when it comes to medical screw-ups, honesty is the best policy.

Heightened Scrutiny of Food & Supplement Health Claims

Health claims made by food and nutritional supplement manufacturers should face the same level of regulatory scrutiny as those made by drug and medical device manufacturers, says a new report from the Institute of Medicine (IOM).

Food and nutritional supplement marketers often make health claims based on how individual ingredients in their products affect biomarkers (physiological characteristics that can be measured and evaluated objectively) such as cholesterol or glucose levels or tumor size. Thus, the manufacturer of a breakfast cereal that contains a cholesterol-lowering ingredient, such as fiber, might boast that its cereal has heart health benefits without clinical proof of improved outcomes.

Faced with a proliferation of health claims being made by food and supplement manufacturers, the FDA’s Center for Food Safety and Applied Nutrition asked the IOM in 2008 to recommend a framework for the evaluation of biomarkers.

Commenting on the report, IOM member Harlan Krumholz, MD said, “This is a groundbreaking report that tells us we should really think carefully about the use of biomarkers and surrogates.”

SRxA’s Word on Health is pleased to hear that the food we eat will be given as much attention as the drugs we take, but hopes that the process can be somewhat faster!

Medicine for Marketers

We were interested to learn that physicians are now turning the tables and offering education to the pharmaceutical industry.

For years, the pharmaceutical industry has been involved, either directly or indirectly, with the provision of education to doctors. New guidelines seem certain to change all that. As previously noted in Word on Health, the ACCME, IOM, AMA and others are all seeking to limit the financial relationship between industry and clinicians.

In a joint effort between the University of Chicago Booth School of Business and the University of Chicago Medical Center, a program entitled Understanding the New Breed of Healthcare Decision Makers will launch this May.

The program will focus on the healthcare issues that will dominate the next decade and is designed to provide an insider’s view on how decisions are made by physicians and hospital administrators.

Over the course of five tightly packed days, the course aims to provide sales, marketing, and product management personnel from the pharmaceutical, device and biotech industry with the skills to:

• Improve sales and marketing decision making skills by exploring the doctor-patient relationship and gaining insight into how physicians and surgeons make decisions
• Better anticipate the business impact of current healthcare issues
• Improve marketing strategies by exploring modes of thinking within medical specialties and subspecialties
• Make better resource deployment decisions as the result of improved understanding of hospital supply chain, purchasing, patient flow and operations
• Better anticipate market needs as the result of exposure to key opinion leaders
• Improve product & service positioning strategies by learning how doctors and hospitals define value
• Better understand and empathize with customer s through a unique immersion experience  in clinical settings

The cost for the course will be $7,650.

SRxA’s Word on Health would love to hear from you if you’ve signed up.