In 1999, the Institute of Medicine conducted a landmark study, "To Err is Human," which reported that nearly 100,000 people die in hospitals each year due to preventable medical errors.
The number seemed so large at the time that many were convinced it was a gross over-exaggeration. Experts now say that figure was too low and hospitals have been too slow to make improvements.
"It was clearly an underestimate of the toll of human suffering that goes on from preventable medical errors," Ashish Jha, MD, professor of health policy and management at Harvard School of Public Health, said at a congressional hearing last week.
The hearing, before the Senate Subcommittee on Primary Health and Aging, was held in response to a new study recently published by the Journal of Patient Safety. The study concludes that a whopping 440,000 people die each year from preventable medical errors in hospitals -- that’s more than 1,000 people a day. Plus, tens of thousands also die from preventable mistakes outside hospitals, such as deaths from missed diagnoses or because of injuries from medications.
Another 10,000 suffer from serious complications due to medical errors each day.
There has been some progress, Dr. Peter Pronovost of Johns Hopkins University testified. Yet thousands of patients still are dying unnecessarily from infections, preventable blood clots, adverse drug events, falls, over exposure to medical radiation and diagnostic errors.
"We need to declare right now that preventable harm is unacceptable and work to prevent all types of harm," Pronovost said.
In addition to deaths and injuries, medical errors also cost billions of dollars, according to U.S. Sen. Bernie Sanders, I-Vt., who chairs the panel.
One 2011 study put the figure at $17 billion a year. Counting indirect costs like lost productivity due to missed work days, medical errors may cost nearly $1 trillion each year, according to a 2012 report in the Journal of Health Care Finance.
"Medical harm is a major cause of suffering, disability, and death -- as well as a huge financial cost to our nation," Sanders said at the outset of the July 17 hearing.
Lisa McGiffert of Consumers Union spoke about the everyday impact on individuals and families. "People who are harmed lose their jobs, their homes, their insurance. Many go bankrupt trying to pay the medical bills that they would not have had if they had not been harmed by a health care provider," she said.
"It is insidious and something that puts every one of us at risk every time we or a loved one enters a hospital or clinic," Bill Crounse, MD, Microsoft’s worldwide health senior director, wrote in HealthBlog.
Healthcare IT News (yes, there’s a website for that) called it "a chilling reality" that preventable medical errors persist as the number three killer in the United States -- third only to heart disease and cancer.
The website points out one common agreement on a root cause of this problem: Information technology is falling short in many areas, including diagnoses, patient safety, managing test results and other medical information.
Jha told the Senate panel there’s been so much hype around electronics health records, with the industry showing "phenomenal progress" with adoption and use. "But the potential is not going to be realized unless those tools are really focused on improving patient safety. The tools themselves won’t automatically do it."
Despite the vast sums expended on electronic records, we really shouldn’t be too surprised that medical mistakes still happen, Crounse wrote in HealthBlog. He notes that electronic medical records are really little more than the digitization of our old paper record systems.
And while some attempt has been made to reduce medical errors with e-prescribing, computerized physician order entry, clinical care guidelines, check lists, adverse alerts, and the like, he said computers are still susceptible to human error.
"Did we really think our baby steps to digitize the paper record in electronic systems would by itself significantly reduce the proliferation of medical errors?" Crounse asks.
At the same time, however, he cautions against relying too much on computers.
"What is drawn to our attention here is the delicate balance we must maintain between human and machine control. The machine is most certainly capable these days of holding and processing more information than the human brain can handle. On the other hand, if the machine only confuses the human brain or the human becomes too complacent in trusting the machine to always perform with perfection, then errors will still happen, in abundance, in our hospitals and clinics," Crounse wrote.
"To err isn’t limited to humans," he added. "Sometimes, machines err too. Sometimes both humans and machines together are to blame. But ultimately, at least for the time being, it is only the human that can improve the machines and make them less likely to contribute to the mistakes made by humans."
On that note, Crounse issued a request:
"If you are a developer, engineer, computer scientist, or concerned clinical end user, please rise up to that challenge!"
Meanwhile, the medial profession needs to take steps to reduce the incidents of human error. This undoubtedly will require more staffing at hospitals, more training for medical professionals and more cross checking of records and procedures to ensure maximum efficiency and accuracy. Of course, this will cost money upfront, but think of the billions or trillions we will save in the long run, not to mention saving a few hundred thousand lives a year.