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Errors in Health Care

Reducing Errors in Health Care Medical errors are responsible for injury in as many as 1 out of every 25 hospital patients; an estimated 48,000-98,000 patients die from medical errors each year. Errors in health care have been estimated to cost more than $5 million per year in a large teaching hospital, and preventable health care-related cost the economy from $17 to $29 billion each year.

AHRQ research has shown that medical errors may result most frequently from systems errors—organization of health care delivery and how resources are provided in the delivery system.

Patients at Risk

Medical errors may result in:

    A patient inadvertently given the wrong medicine.

    A clinician misreading the results of a test.

    An elderly woman with ambiguous symptoms (shortness of breath, abdominal pain, and dizziness) whose heart attack is not diagnosed by emergency room staff.

Errors like these are responsible for preventable injury in as many as 1 out of every 25 hospital patients.

Errors in health care have been estimated to cost more than $5 million per year in a large teaching hospital. According to a recent report by the Institute of Medicine (IOM), preventable health care-related injuries cost the economy from $17 to $29 billion annually, of which half are health care costs.

The IOM report estimates that 44,000 to 98,000 people each year die from medical errors. Even the lower estimate is higher than the annual mortality from motor vehicle accidents (43,458), breast cancer (42,297), or AIDS (16,516), thus making medical errors the eighth leading cause of death in the United States.

These and other findings of the IOM report are based on research sponsored by a variety of organizations, including the Agency for Healthcare Research and Quality (AHRQ).

For example, a study by AHRQ4 found that just one type of error—preventable adverse drug events—caused one out of five injuries or deaths per year to patients in the hospitals that were studied.

How Errors Occur

Errors can occur at any point in the health care delivery system, AHRQ-supported research has revealed.

Medication Errors

These are preventable mistakes in prescribing and delivering medication to patients, such as prescribing two or more drugs whose interaction is known to produce side effects or prescribing a drug to which the patient is known to be allergic.

Research by AHRQ-supported investigators is helping to characterize these errors (called preventable adverse drug events, or ADEs) and suggest how to prevent them.

In a study of inpatient care in two tertiary care hospitals5, errors in ordering and administering medicines accounted for 56 and 34 percent, respectively, of preventable adverse drug events.

Findings from a second 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.

An attempt to identify risk factors for preventable adverse drug reactions among patients admitted to medical and surgical units at two large hospitals found few such factors, which suggested to the researchers that a focus on improving medication systems would prove more effective.

Surgical Errors

In contrast to ADEs, surgical adverse events (1 in 50 admissions in Colorado and Utah hospitals during 1992), accounted for two-thirds of all adverse events and 1 of 8 hospital deaths in a recent retrospective study of these institutions by an AHRQ fellow.

Diagnostic Inaccuracies

Incorrect diagnoses may lead to incorrect and ineffective treatment or unnecessary testing, which is costly and sometimes invasive. Also, inexperience with a technically difficult diagnostic procedure can affect the accuracy of the results. Here, too, AHRQ-funded researchers have made major contributions.

One 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.

System Failures

Although errors in medication, surgery, and diagnosis are the easiest to detect, medical errors may result more frequently from the organization of health care delivery and the way that resources are provided to the delivery system. Research by AHRQ-supported scientists is helping to identify the systemic factors contributing to preventable adverse events.

Investigators in a major study6 discovered that failures at the system level were the real culprits in over three-fourths of adverse drug events.

Failures in disseminating pharmaceutical information, in checking drug doses and patient identities, and in making patient information available are system errors that accounted for adverse drug events in over half of the hospitals studied.

One system-level factor, staffing levels of nurses (adjusted for hospital characteristics), was found in a study to influence the incidence of adverse events following major surgery, such as urinary tract infections, pneumonia, thrombosis, and pulmonary compromise.

This research on systemic problems leads investigators to conclude that any effort to reduce medical errors in an organization requires changes to the system design, including possible reorganization of resources by top-level management.



This information came from an
AHRQ online article.

*** Any law, statute, regulation or other precedent is subject to change at any time ***

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