They might be known by the term "never events," but a newly released analysis from Johns Hopkins University, Baltimore, finds that serious surgical errors, such as wrong-site surgery and objects retained after procedures, are alarmingly common in U.S. hospitals.
Using a federal database of paid malpractice claims, researchers found 9,744 malpractice settlements and judgments for surgical never events during the past two decades, totaling $1.3 billion in payments. Based on that data and on previous data about rates of payment for such cases, they estimated that 4,082 claims for surgical never events were filed each year—the equivalent of more than 80,000 events since 1990.
"There are mistakes in healthcare that are not preventable," the study's lead author, Dr. Marty Makary, associate professor of surgery at Johns Hopkins University School of Medicine, said in a news release. "Infection rates will likely never get down to zero even if everyone does everything right, for example. But the events we've estimated are totally preventable. This study highlights that we are nowhere near where we should be and there's a lot of work to be done."
Of the 9,744 paid claims, 6.6% of patients died and nearly 33% suffered permanent injury, according to the study, which appeared in the journal Surgery.
The authors argued that their findings should highlight the need for more aggressive process-improvement efforts, including a greater focus on human-factors engineering and hospital culture. They also advocated the use of checklists, preoperative timeouts and other evidence-based interventions. Finally, they said that their data points to the need for more effective data collection.
"For a fraction of the costs associated with surgical never events, we can monitor patterns of these errors better and ultimately discover effective approaches to eliminating them," they wrote in the study.
The CMS includes foreign object retained surgery, wrong-site surgery, wrong-patient surgery and wrong-procedure surgery in its list of conditions designated for nonpayment. Many other private payers also have such policies for never events.