Most patients at most hospitals receive excellent care and recover from illness, injury or procedures in due course, It's long been known, however, that there is some risk associated with a hospital stay. How common those risks might be has been a subject of intense debate and extensive research. The reason for such interest is obvious. Hospitals and those who work in them are supposed to heal, not to do harm. Learning where, when and how often errors occur is often the first step in reducing the problem. If that's the case, a new study should be enormously instructive.
The study, published last week in the Health Affairs journal, suggests that hospital errors occur significantly more often than reported. Indeed, the study conducted at three U.S. teaching hospitals indicated that as many as 90 percent of hospital errors might be missed by methods currently in place to detect them. It also indicated that as many as a third of all those admitted might be affected by a so-called "adverse event." Even for those long concerned about patient safety, those numbers were startling.
A carefully monitored review cited in the study discovered 354 "adverse events" at the hospitals among a group of patients within a specific period of time. A system designed by a federal agency to detect errors identified 35 cases among the same patients, while the hospitals' own, voluntary reporting programs reported only four errors. The discrepancies are cause for worry - for patients, obviously, but also administrators, medical personnel and others working to reduce errors that are physically, emotionally and economically costly.
The medical errors reported in the study - most often pressure or bed sores, bloodstream and other infections and medication errors, but not limited to them - aren't necessarily life-threatening in every instance, though they can be. Indeed, tens of thousands of deaths a year have been linked to errors made in hospitals.
The higher number of errors reported in the study was detected by a system that employs a "global trigger tool," a checklist that involves third-party reviews of medical charts by third-party physicians, nurses and pharmacists. If additional research and study confirms the validity of the report in Health Affairs, it's obvious that the current method of detecting errors - often involving the use of administrative data rather than hands-on examination of records - presents a flawed picture of patient safety and medical errors in the nation's hospitals. That's good to know.
The purpose of the study is not to point fingers at specific offenders, but to acknowledge the problem, develop more useful tools to track medical errors in in-patient and out-patient hospital settings, and then create methods to reduce them. The admirable goal is to make a hospital visit safer and to reduce the risk of an "adverse event" that could sicken or injure a patient, lead to a longer hospital stay or readmission for a patient or lead to disability or death.
Despite measurable progress in reducing overall mortality and infection rates at U.S. hospitals in recent years, the twin problems of hospital errors and patient safety remain a concern. How could that not be the case given the suffering and costs (an estimated $18 billion or more annually, according to some authoritative sources) associated with them? Resolution will be difficult, but acknowledgment of the problem is beneficial.
New methodologies like the "global trigger tool" can help reduce hospital errors and improve patient safety, but that is just one part of what will have to become a far broader effort. Improved standards of health care delivery, increased advocacy by and for patients and attention to detail and procedures by medical and other health-care personnel in the hospital setting also are crucial to the effort. Without them, errors will continue to be made and patient safety will continue to be compromised.