A physician revealed to me, that the medical community may have already recognized, what researchers published in a new study to the general public. The revelation that medical errors account for a number of deaths that would rank it as the third leading cause of death in the United States.
Here is the link to the BMJ talk medicine audio interview where the lead author of the study Dr Martin Makary (a professor at the John Hopkins School of medicine), talked about the findings published in the May 4, 2016 BMJ Journal, section Analysis. Dr. Makary and coauthor Michael Daniel analyzed data from other studies, which took place between 2000 to 2008 and estimated the number to be “251,000” deaths per year “, that equates to nearly 700 deaths a day — about 9.5 percent of all deaths annually in the United States.” (The Washington Post “Researchers: Medical errors now third leading cause of death in United States,” May 3). The author talks about how he believes this is conservative number. Lets hope this brings to the forefront discussions about patient safety and strategies to address these staggering numbers.
The article reveals that the high prevalence rate is not unique to the US. Dr. Markary emphasizes that this is a public health awareness, health policy and public health priorities issues, as research and funding is set by numbers, and that these distressing numbers may not be getting the attention needed since deaths by medical errors are not captured separately as a category on death certificates.
He is advocating the Centers for Disease Control and Prevention for changes to the way such deaths are reported so that they may be included in the national statistics collected. The US collects causes of death according to medical coding system of the International Classification of Diseases (ICD-9), a version of coding system that is old and outdated. It is not detailed enough to describe patient diagnoses and modern medical services and procedures, uses antiquated terminology and collects limited patient data. It was developed at nearly 36 years ago and the medical landscape has changed a lot since then, especially according to Dr. Makary “At that time, it was under-recognized that diagnostic errors, medical mistakes, and the absence of safety nets could result in someone’s death,”. In addition Makary says, “and because of that, medical errors were unintentionally excluded from national health statistics.”
The article also brings to light that the medical errors can span the spectrum from systemic glitches, medication errors, poor communication that lead to insufficient coordinated care, lack of safety nets established or inadequately instituted, inconsistent protocols for treatment and care, disjointed insurance networks, disparity in physician practice patterns that lack culpability. Finally there is lack of transparency from hospitals that have safety boards that is not open to the public due to risk of litigation.
Another article that was released within the same month divulged that in the USA “approximately 30% of outpatient prescriptions were inappropriate, approximately one in three antibiotics prescribed in outpatient settings in the United States are unnecessary”, according to recent data published in JAMA (Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA. doi:10.1001/jama.2016.4151.) . This outlines the need, at least, of a more widespread promotion of antibiotic stewardship by physicians. A lot progress has already taken place in safety systems, such as computerized medication prescription ordering system (that alerts doctors for errors), but there is still place for improvement.
We have all heard about sensationalized nightmare stories of errors or may even know someone who could have lived longer but an untimely medical error occurred. Wow, the numbers just give it perspective. Even though tremendous changes are in progress, hoping this gets attention, and we advocate for the health care professionals to embrace the new changes from ICD-9 to ICD-10. It will surely thrust the healthcare industry forward, and ICD-10 is a significant step in that process.
Some suggest that transparency will assist in the standards of accountability and better delivery of health care. Accountability in health care is always being advancing forward and more data needs to be collected in a manner that does not take time away from the already time strapped medical health care professionals. It is essential that this be done with a balanced approach, with the costs of such data gathering impact more palatable to the health care institutions and hopefully no health care costs to be shifted to the already burdened patients.
I was made aware that there is a new initiative being promoted by the federal Agency for Healthcare Research and Quality (AHRQ) called CANDOR-“The Communication and Optimal Resolution (CANDOR) – A system/process “that health care institutions and practitioners can use to respond in a timely, thorough, and ethical way when unexpected events cause patient harm”. This surely would be a game changer, a culture shift towards an enhanced, transparent team approach for patient safety-a more evidence- based process for “improvements in the monitoring and reporting of events by promoting candid, empathic communication and timely resolution for patients, caregivers, and the organization”.
Until we see the above implemented and the results tallied, currently for patients, it’s a team approach that can help reduce your chance of medical errors. You or your family members are your best bet to be a safety advocate for your health. Although healthcare reform continues to evolve toward better patient safety and care, stakeholders speaking up will always help tremendously. The health safety advocate’s role is pivotal in the delivery of safer health care.
What are your thoughts, please do share.
Photo Credit: N0037339 Doctors during a handover, UK by Wellcome Images CC BY-NC-ND 2.0
Martin A Makary, Michael Daniel. Medical error—the third leading cause of death in the US. BMJ, 2016; i2139 DOI: 10.1136/bmj.i2139