A new study has touched off renewed debate about a vexing issue that has preoccupied the healthcare community for the past two years: the annual death toll from medical errors in U.S. hospitals.
But instead of continued hand-wringing over "body counts" from medical mistakes, the provider community should instead focus squarely on maintaining its momentum in patient-safety initiatives, observers suggest.
The new study, which examined patient deaths at seven U.S. Department of Veterans Affairs hospitals, suggests the oft-cited medical-error statistics in the blockbuster 1999 Institute of Medicine Report are "probably unreliable" and "misleading."
It implies that the number of preventable deaths attributable to medical errors is anywhere from 5,000 to 15,000-far below the widely publicized 44,000 to 98,000 figures in the IOM's 1999 report To Err is Human, which received so much national attention.
"The hospital field's focus all along has been working to improve patient safety," said Carmela Coyle, senior vice president for policy at the American Hospital Association. "There may have been questions about the numbers, but the issue and the need to focus on improved patient safety remains."
The study, which appeared in the July 25 issue of the Journal of the American Medical Association, contends that medical errors are to blame for only two to three patient deaths per 10,000 hospital admissions. That's well below previous estimates that placed the number of patient deaths related to medical errors at about 15 or more per 10,000 admissions, said Rodney Hayward, M.D., director for outcomes research at the Ann Arbor (Mich.) VA Health Care System and co-author of the JAMA study.
"We're not contradicting (reports) that errors are common-the study confirms that," Hayward said. "(But) it suggests that the number of deaths due to errors, at least (those identified through chart review) have been overestimated."
Lucian Leape, M.D., an adjunct professor at the Harvard School of Public Health who helped write the 217-page IOM report, criticized the JAMA survey, saying it was based on an uncharacteristic group and a tiny sample-just 111 patient deaths between 1995 and 1996.
"Most of us have stopped trying to count bodies," Leape said. "The (IOM) report has galvanized a growing effort in the healthcare system to reduce medical errors. And that job seems to be flourishing. The answer to this problem is not to know exact numbers-it's to know what the problems are and how to solve them."
Richard Cook, M.D., a member of the board of directors for the Chicago-based National Patient Safety Foundation, said the commitment of his group and others to patient safety "is not going to be changed because of one article or another."
"The foundation has never been focused on trying to establish numbers-we've never thought that was a particularly productive way to address the issue," he said.
Hayward's study concludes that 6% of the patients would have lived if they had received optimal care, but that only about one-half of one percent-or roughly one per 10,000 admissions-would have lived another three months or more in good health.
"As a consumer, I would be interested in knowing what the hospital's safety record is, and what is the likelihood that a serious error will occur," said Janet Corrigan, director of the board on healthcare services for the IOM, "regardless whether the life expectancy was three months, six months or six years."