Medical error is the third leading cause of death in the U.S., killing more than 250,000 people each year. But the problem is not being tracked widely, according to an analysis published Tuesday in the BMJ.
When a medical error results in death, the delivery of care issue that led to the death should be tracked, said Johns Hopkins University School of Medicine professor, Martin Makary and research fellow Michael Daniel in their analysis. But the problem is not currently reported explicitly as a cause of death to the Centers for Disease Control and Prevention, or on death certificates. And it is not easily tracked through the diagnostic and procedural coding system used by hospitals and other providers.
“The science of improving safety should benefit from sharing data,” Makary and Daniel wrote. “In the same way as clinicians share research and innovation about coronary artery disease, melanoma and influenza.”
They found that medical mistakes trailed heart disease, which led to 611,000 deaths, and cancer, which led to 585,000 deaths. The study analyzed scientific literature reported since 1999 to identify how big a contribution the mistakes play in U.S. deaths.
While the findings raise eyebrows, critics of the study point out that important progress has been made in recent years.The BMJ study does not take into account studies from 2008 and beyond.
For example, in December, the HHS lauded estimates which found that hospital patients experienced 2.1 million fewer hospital-acquired conditions from 2010 to 2014. As a result, about 87,000 fewer patients died in hospitals, saving lives and money, to the tune of nearly $20 billion.
It doesn't mean that things are perfect, said Rick Pollack, president and CEO of the American Hospital Association. “No matter the number, one incident is one too many.” However it does show that hospitals are constantly working to improve patient safety.
The BMJ study has raised the ire of some.
“It is a profound public health disservice to compare such a cavalier characterization of "medical error" with entities as systemic and chronic as cardiovascular disease and cancer,” contended Dr. Benjamin Wei, a surgeon from Phoenix, in a response to the post.
Casting light in a “field of sizable consequence that lacks concrete data” is an admirable goal, he said. “What I protest, however, is the hyperbole that they have resorted to in order to achieve that aim.”
Others, however say that the study points out that while there are many different tools used to try to track the problem, there are no well-established ways to calculate mortality caused by medical harm at this point.
“The numbers are everywhere,” said Frank Federico, vice president of the Institute for Healthcare Improvement.
He and the BMJ authors noted the limited ability of coding software to track the problem, as those serve more of a business function and less of quality improvement. But the demand is growing to figure it out, to more effectively track the problem of medical mistakes, Federico said. The IHI uses something called a trigger tool to search through patient records and identify adverse events retrospectively.
“There are people who push back and say not everything is preventable. We agree," Federico said. "But we'd rather consider everything and then learn how to prevent it, rather than assume it is not preventable and not worry about it.”