An earlier Johns Hopkins study looked at diagnostic errors and determined that such errors were the leading cause of malpractice payouts. Can clinical laboratories help?
At a time of heightened transparency in healthcare outcomes, a Johns Hopkins University School of Medicine (Johns Hopkins) study makes a startling conclusion: medical errors are an under-recognized cause of patients’ deaths in the United States. In fact, medical errors rank third—after heart disease and cancer—in causing patients’ deaths, according to a Johns Hopkins statement.
This finding has many implications for pathologists and clinical laboratory managers. Often, medical errors are associated with the failure of physicians to order correct medical laboratory tests at critical junctures. Alternatively, a medical error can result if the physician fails to take appropriate action after getting an accurate lab test result. Thus, any effort within the health system to reduce medical errors will probably bring pathologists and medical laboratory scientists into closer consultation with clinicians.
What the researchers at Johns Hopkins also learned during their study is that medical error is not reported as a cause of death on death certificates. Further, the Centers for Disease Control and Prevention (CDC) has no “medical error” category in its annual report on deaths and mortality, The New York Times (NYT) reported.
Nearly 10% of U.S. Deaths Due to Medical Errors
The Johns Hopkins researchers analyzed medical death rate data from 2000 to 2008. They examined four studies, including those by the U.S. Department of Health and Human Services’ Office of the Inspector General (HHS) and the Agency for Healthcare Research and Quality (AHRQ). They then calculated a mean rate of death from medical error. The rate was applied to annual hospital admissions, the NYT explained.
The researchers concluded that an average of 251,454 deaths, or 9.5% of all U.S. deaths per year during that period, were due to medical errors. They offered up a comparison to 2013 CDC data, which suggest:
• 611,105 deaths are caused by heart disease;
• 584,881 deaths are due to cancer; and
• 149,205 deaths are due to chronic respiratory disease, which is the fourth cause of death in the U.S. after medical errors, the Johns Hopkins study noted.
Researchers Call for Error Reporting, Transparency
Martin Makary, MD, Professor of Surgery at Johns Hopkins and lead researcher, suggested in a Washington Post (WP) article that the CDC should update its vital statistics reporting requirements to enable doctors to report errors related to preventable deaths.
“We all know how common [medical error] is. We also know how infrequently it’s openly discussed,” Makary said in the WP interview.
Bringing attention to deaths due to medical error has another benefit. The issue may garner funding from sources and escalate to a public health priority, researchers say.
“Instead of simply recording cause of death (with an ICD code), death certificates should contain an extra field asking whether a preventable complication stemming from the patient’s medical care contributed to the death,” noted the researchers in an article about the study in the British Medical Journal (BMJ).
According to the study, most medical errors are due to factors that can include:
• uncoordinated care;
• fragmented insurance networks; and
• lack or underuse of safety nets.
In other words, doctors and other caregivers might not be involved at all. Sometimes a faulty computer program could be to blame, the Los Angeles Times noted in its story about the study.
Can Health IT Be Responsible for Medical Errors?
For example, in the fast-paced environment of a busy ER, a nurse might enter the right symptoms in the wrong person’s file when she cannot clearly see the patient’s name on the computer display, KHN noted.
“There are new categories of patient safety errors,” said Raj Ratwani, PhD, Scientific Director for MedStar Health’s National Center for Human Factors in Healthcare.
KHN pointed out that many ERs are transitioning from “homegrown” information technologies to enterprise-wide hospital information systems.
Ratwani suggests that these adjustment periods can negatively affect caregivers’ ability to provide quality care. “Rapid task-switching leads to increased stress and frustration and can have serious patient implications. Multi-tasking rarely improves human performance,” he said.
Another research study published in 2013 by the Johns Hopkins School of Medicine addressed the issue of diagnostic errors. In a press release titled, “Diagnostic Errors More Common, Costly and Harmful than Treatment Mistakes,” the researchers summarized their findings.
The press release stated, “In reviewing 25 years of U.S. malpractice claim payouts, Johns Hopkins researchers found that diagnostic errors—not surgical mistakes or medication overdoses—accounted for the largest fraction of claims, the most severe patient harm, and the highest total of penalty payouts. Diagnosis-related payments amounted to $38.8 billion between 1986 and 2010, they found.”
Taken together, these two studies about medical errors and diagnostic errors represent more steps forward in efforts to put more attention on these problems. One requirement is to gather data about such problems, as described above. It would be an interesting turn of events if healthcare researchers investigating the cause of diagnostic errors began to engage clinical pathologists in their studies. That’s because pathologists often know which physicians in their communities have the best diagnostic skills and which have the worst.
—Donna Marie Pocius