Avoiding Medical Errors in the Hospital
Mistakes happen in every line of work. But when they happen in medicine, mistakes can be deadly. And new findings suggest medical errors happen more often than any of us would like to think.
Fifteen years ago, the Institute of Medicine estimated that 44,000 to 98,000 Americans died annually as a result of medical errors. At the time, some researchers thought those numbers were likely too low.
Now, a reanalysis of multiple types of existing data by researchers at Johns Hopkins University School of Medicine suggests that the toll is likely much higher than originally thought—more than 250,000 deaths a year. If that number is correct, it means a shocking 9.5 percent of the deaths that occur each year in the United States are the result of a complex healthcare system gone awry.
The findings, published in published in May 2015 in BMJ,, show medical errors would be the third leading cause of death after cancer and heart disease if they were considered a disease listed in death certificates.
Focusing on a ‘hidden’ problem
Even the Hopkins researchers acknowledge their number is a best guess and may be an underestimate. For starters, there’s no agreed-upon method to define what constitutes a medical error. Patients may die of something obvious, such as a mishandled operation, or something harder to pinpoint, such as a lack of follow-up care. Death certificates typically list diseases or injuries with the same standard codes (called ICD codes) used for billing. Those codes don’t include treatment errors, so such errors aren’t reported.
To come up with its estimate, the Hopkins team examined four separate data sources of medical death rates from 2000 to 2008 and then extrapolated the numbers to the U.S. population based on more than 35 million hospitalizations in 2013. Whatever the actual amount, says William Dale, M.D., Ph.D., associate professor of medicine and section chief of Geriatrics & Palliative Medicine at the University of Chicago Medicine, “virtually everyone agrees that too many patients are hurt and die because of medical errors, especially those in hospitals. The new study sheds important light on a problem about which we know far too little. The more we learn about the extent of medical errors and why they happen, the better chance we’ll have of preventing them.”
What you can do
“The reality is, medical care will always carry risks, ranging from surgical complications to adverse drug reactions to hospital-acquired infections,” Dale says. “Fortunately, there is plenty that patients and their families can do to lower risks, starting with becoming more involved in their own medical care and decision making.”
Here’s how you can be an active part of your hospital healthcare team:
• Do your homework. If you need surgery or a less invasive procedure and have time to choose where to go, take some extra time to evaluate your options. Most hospitals make data about patient safety available to the public. If you need surgery, make sure your surgeon has extensive experience performing that procedure—as should the hospital where the surgery takes place. Ask how many of those procedures he or she has performed and what sort of complications have arisen. Get a second opinion if you have doubts; any good surgeon would welcome one.
• Know exactly what to expect. Be sure you and your loved ones understand what is planned during your hospital stay. Inquire about what will happen during and after the procedure, in recovery, prior to discharge, and even after leaving. Always know the expected next step in your care each day in the hospital. If you don’t understand something, ask your doctor or nurse to explain. Writing things down is always a good idea. You may also be too sick or busy recovering to be fully aware of your surroundings. Try to have a relative or friend with you to ask questions and follow the answers during consultations.
• Manage your meds. Adverse drug reactions and interactions rank among the most common problems in the hospital. To help avoid trouble, be sure that all your caregivers are aware of the medications you regularly take, including prescription medications, over-the-counter drugs, and nutritional/herbal supplements, and keep a list at your bedside. If a doctor prescribes a new drug during your hospital stay, understand exactly how to take it, when you’ll be taking it, and why you’re taking it. Ask about side effects and interactions with current medication and what to do if they occur.
• Be vigilant. Speak up. Don’t be reluctant to ask doctors, nurses, or attendants if they’ve washed their hands. Hand-washing is one of the best ways to prevent hospital-acquired infections, such as blood, surgical site, or urinary tract infections. If your doctor orders special precautions for visitors, such as the use of face masks or special gowns, make sure that everyone follows the rules. Ask visitors to wash their hands before touching you, too.
• Be alert to signs of infection. If you experience redness, soreness, pain, or drainage at a surgical or intravenous (IV) catheter site, tell your nurse or doctor immediately. Make sure any central-line or urinary catheter is changed regularly, and each day ask whether you still need it, since the risk of infection increases the longer it remains in; catheters are a leading source of hospital-acquired infections. If you have three or more bouts of diarrhea in 24 hours, speak up. It could be a sign of a Clostridium difficile infection, which causes inflammation of the colon and can be life-threatening. Diarrhea, vomiting, fever, or a sore throat may also be signs of sepsis, a blood infection.
• Don’t get tripped up. Being in the hospital increases your risk of falling, especially when you’re weakened, tired, and attached to IV lines, urinary catheters, and oxygen tubes. To avoid falling, ask for help getting out of bed, particularly if you’re not sure whether you’ll be steady on your feet. Don’t use your IV pole, bed tray, or any movable object to hoist or steady yourself. Wear nonskid slippers during your stay. Keep eyeglasses, hearing aids, cell phones, call buttons, and any personal possessions you may need within easy reach.
• Know your tests. Knowledge is power. Ask why a test is being done, and speak up if you have concerns about the need for it. Request that any test results be explained to you. Asking also keeps the staff alert to your status and the need for potential changes in your treatment plan.
• Ask to be involved in handoffs. A “handoff” occurs when care and patient information are transferred from one healthcare team or unit to another, such as during a shift change in the hospital, when doctors transfer care to another specialist, or when an anesthesiologist transfers care to a recovery room nurse.
The risk for medical errors increases during handoffs. If you’re privy to the handoff discussion between doctors or teams, you can confirm your care instructions or next management steps and address any omissions about your health, such as drug allergies or a special diet. Moreover, it may help staff to remember key facts if they can visually associate them with you.
• Chart your course of recovery. The transition from hospital to home, perhaps with a stay at a rehabilitation facility in between, can be tricky. Much like hospital handoffs, these times when care is being transferred to others is fraught with dangers.
“Be sure to ask your doctor and other care team members about the follow-up care you will need when you leave the hospital,” Dale advises. “If you aren’t sure you can manage on your own, ask about resources in the community, such as visiting nurses, physical therapy, homemaker, or food-delivery programs. Ask about complications you should be on the lookout for, such as a fever, light-headedness, or worsening pain, and whom to call if you have complications or questions.”
When things go wrong
We’ve all heard horror stories of surgeons operating on the wrong leg or leaving scalpels inside patients. In fact, botched surgeries are very rare. The most preventable problems in hospitals include:
• Drug events— Allergic reactions, dosage errors, taking the wrong medication, adverse drug interactions
• Deep vein thrombosis— Blood clots can form, most often in a leg, after surgery or prolonged bed rest
• Falls— Which can add an average of more than six days to a hospital stay if the patient is injured
• Bedsores— Also called pressure sores, which afflict an estimated 2.5 million Americans every year
• Pneumonia— A common and potentially fatal complication, which occurs when patients are confined to bed
• Diagnostic errors— One of the most serious: failing to identify a heart attack