Emerging Trends: Medical Errors

Larry Tremonti, M.D., Associate Editor

The serious problem of medical errors is not new, but in the past, the problem has not gotten the attention it deserved. The Institute of Medicine (IOM) estimates that medical errors cost the nation approximately $376 billion each year; about $17 billion is associated with preventable errors. A body of landmark research conducted by Lucian Leape M.D. and David Bates, M.D. has begun to shed light on the magnitude of this issue. In fact, medical errors has been identified as one of the four major challenges facing the nation in improving health care quality.

Public attention has begun to focus on medical errors, and the reality of its magnitude has been evident in more recent consumer research. In a poll by the National Safety Foundation:

  • 42% of respondents had been affected by a medical error, either personally or through a friend or relative;
  • 32% of respondents indicated that the error had a permanent negative effect on the patient's health.
  • Clearly, the impact of medical errors is perceived as being substantial by the public. Overall, they consider the health care system to be only moderately safe.

Another survey by the American Society of Health Systems Pharmacists found that Americans are concerned about:

  • being given the wrong medicine (61%);
  • being given two or more medicines that interact in a negative way (58%);
  • complications from a medical procedure (56%);

Again, the public is concerned and believe that medical failures are the result of the failures of individual providers. When asked about possible solutions to these issues

  • 75% of respondents thought it would be most effective to keep health professionals with bad records from providing care;
  • 69% thought the problem could be solved through better training of health professionals.

While the public perception focuses on the individual failure, the IOM emphasized that most medical errors are systems related and not attributable to individual neglect or misconduct. The key to reducing medical errors is to focus on improving the systems of delivering care, not to blame individuals. Perhaps if we as a profession have failed, it's because of not improving the system of care — even in our offices.

Federally supported research by the Agency for Health Care Policy and Research (AHCPR) reveals that errors can occur at a variety of points in the health care delivery system.

  • Medication Errors: In one AHCPR study of inpatient care in two tertiary care hospitals, errors in ordering and administering medicines accounted for 56% and 34%, respectively, of preventable adverse drug events. Findings from another study showed that dosage errors, in particular, were primarily due to the physician's lack of knowledge about the drug or about the patient for whom it was prescribed.
  • Diagnostic Inaccuracies: Incorrect diagnoses may miss serious conditions or lead to unnecessary additional testing, which may be costly and sometimes invasive. Also, inexperience with technically difficult procedures can affect the accuracy of the results. One AHCPR study showed that physicians who performed 100 or more colposcopies (a test used to follow up abnormal Pap smears) a year had more accurate findings than physicians who performed the procedure less often. Another study demonstrated that measuring blood pressure with the most commonly used type of equipment often gives incorrect readings that may lead to mismanagement of hypertension. Researchers in a third study found that patients misdiagnosed during hospitalization or discharged from the hospital before they should have been were more likely to be readmitted within one month than other patients.

It is evident from the origins of medical errors, that system issues are pervasive. Access and use of timely information that is valid, legible and comprehensive and fail safe processes of medical care and information delivery are promising avenues and opportunities to be explored. Office practice settings are not immune to these efforts. Indeed most medical care is rendered in an ambulatory setting whether it be the hospital, lab, pharmacy or physician's office.

While our patients hold us in high esteem, they want to be safe in our care and confident that they receive the right treatment, at the right time, for the right condition. If we examine our office environment and focus on the major sources of system error noted above, we can go a long way in eliminating simple errors by establishing a system for

  • legible, accurate medication prescriptions and a current list of medications taken;
  • complete and accurate diagnosis listings on the chart including allergies;
  • medical guidelines / protocols for the patient's condition in the chart to eliminate recall;
  • record of all transactions involving the patient - no verbal messages.

These are just a few of the opportunities for process revision within our reach. In subsequent trend articles, we will highlight what physicians and other providers are doing to systematically eliminate errors. We intend to feature best practices particularly within our community. We would welcome your contribution and invite you to submit your best practice to the journal. We will include as many as possible in future editions.

REFERENCES
Bates DW, Cullon D, Laird N, et al. Incidence of adverse drug events and potential adverse drug events; Implications for prevention, JAMA. 1995; 274: 29-34
Leape LL. Error in medicine. JAMA. 1994; 272: 1851-1857
Bates DW, Kuperman G, Teich JM. Computerized physician order entry and quality of care. Qual. Manages Health Care. 1994; 2(4): 18-27
Jacksonville Medicine / July, 2000

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