By Brendan Faulkner
The Center for Disease Control publishes an annual list of the most common causes of death in the United States. “Medical errors” (i.e. mistakes in diagnosis, poor discharge instructions, and preventable complications such as infections picked up in the facility) is not one of the causes listed, but should be according to a new study by patient safety researchers at Johns Hopkins School of Medicine published in the BMJ.
This newly released research shows that “medical errors” in hospitals and other health care facilities are very common, and should be considered the third leading cause of death in the United States, claiming at least 251,000 lives every year.
The Johns Hopkins research considered evidence from four studies that analyzed medical death rate data from 2000 to 2008, including one by the U.S. Department of Health and Human Services’ Office of the Inspector General and the Agency for Healthcare Research and Quality. Using these data, the researchers were able to calculate a mean death rate for medical errors in U.S. hospitals. Applying this rate to the 35 million admissions in 2013, they calculated that 251,454 deaths resulted from medical mistakes. Moreover, the researchers acknowledge that this figure most likely represents an undercount, because they were unable to capture data from deaths that occur in outpatient clinics, nursing homes and other non-hospital settings. Likewise, they do not capture deaths that occurred soon after patients were negligently discharged.
The study highlights how shortcomings in tracking vital statistics may hinder research and keep the problem out of the public eye. As explained in the BMJ article, the CDC’s list is created using death certificates filled out by physicians, funeral directors, medical examiners, and coroners. However, a major limitation of the death certificate is that it relies on assigning an International Classification of Disease (ICD) code to the cause of death. As a result, causes of death not associated with an ICD code, such as human and system factors, are not captured. In an open letter to the CDC, the authors call for changes in death certificates to better tabulate fatal lapses in care, and urge the CDC to immediately add medical errors to its annual list reporting the top causes of death.
Frightening, interesting, and morbid though the CDC’s list may be, it is critically important that it be accurate because it informs our country’s research and health priorities each year. Here is an excerpt from the open letter as to the significance of tracking causes of death accurately:
“Appropriately recognizing the role of medical error in health care has enormous implications for medicine. Drawing on reliable data, deaths from care … should be addressed with the same resources and vigor as other scientific endeavors. Currently, deaths due to medical error result only in internal discussions in confidential forums such as a hospital’s internal root cause analysis committee or a department’s morbidity and mortality conference.
[The CDC list] informs … national funding campaigns. An accurate list is important to appropriately shape the trajectory of public health initiatives in areas where the most people are being affected.
Reducing costly medical errors is critical towards the important goal of creating a safer, more reliable health care system. Measuring and understanding the problem is the first step.”
The CDC should take the open letter and this research to heart and make the suggested changes. Ultimately however, it is up to hospitals and medical centers to shine a light on the problem. As always, sunlight is the best disinfectant, and the more unseen dangers are brought into the light, the safer all of us will be.
Finally, this research is also a reminder of how strikingly low the number of medical malpractice claims filed in Connecticut each year is, contrary to the popular misconception that these lawsuits are common, or are somehow to blame for escalating health care costs. Nothing could be further from the truth–medical treatment that leads to payment of a malpractice settlement or verdict is the very rare exception to the rule. The overwhelming majority of medical errors go uncompensated. And the cost of medical malpractice claims (which are vital to patient safety, and to our democracy, generally) are a drop in the national healthcare budget.
[For further reading on the Johns Hopkins research in the BMJ, The Washington Post has excellent coverage.]