Tag Archives: Medical Errors

Health Care Costs

Medical Errors: US vs. UK

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The official National Health Service (NHS) estimate of British patient deaths or serious injuries due to medical error is 11,000 cases a year. Yet, according to the Sun on July 3, 2009, the Commons Health Select Committee found that thousands of NHS mistakes are covered up and that a better estimate is that 72,000 patients die each year.

Some health reformers in the United States argue that more government controls on how physicians and hospitals practice medicine will improve quality and reduce patient deaths. Avoidable deaths in the US are now said to range from 98,000 to 195,000 every year. The lower number comes from a discredited Institute of Medicine estimate. The higher number comes from HealthGrades, a hardly disinterested party in the business of selling health care quality measures. Given the size of the US population, if government practice guidelines and pay for performance metrics are as successful under ObamaCare as they have been in Britain, expect the number of US deaths from medical errors to almost double to 360,000 a year.

Physicians

Another Solution to Malpractice

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This is from USA Today:

For nearly a decade, the University of Michigan Health System has been using a program in which patients report errors to a hospital “risk-management” program before filing suit. The hospital investigates and, if warranted, issues an apology and an offer of compensation to the patient. If the patient turns that down, he or she can go to court. The vast majority settle. The system moves quickly, sometimes catching errors before they’re reported.

Physicians

Life in the Trenches

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If certain reformers have their way and electronic medical records are used to control treatment plans, physician actions, and payments, how will mistakes in the record be handled?

WhiteCoat's Call Room reports a case in which the hospital laboratory made an error in measuring a patient's potassium level. The value was so high, the physician ordered another test. The second test showed the potassium level was normal, but the lab report did not show that the test had been done to correct an improbably high value in the original test. The physician asked the lab to send the report from the first test along with the report for the second test in order to justify his order of a second test. The lab said it couldn't do this. Continue reading Life in the Trenches →

Hospitals

“Never Events” are Pay-for-Performance in Disguise

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On October 1, 2008, Medicare announced its first list of “never events.” A never event is something that Medicare believes should never happen and it refuses to pay hospitals when such events occur.

Some of the items on the original October 2008 never event list make sense – surgery on the wrong patient or the wrong body part is obviously inexcusable. So is leaving a surgical instrument in a patient.

Unfortunately the list has expanded to include relatively unlikely but routine complications with the result that Medicare’s “never events” policy has the potential to skew clinical decision making in a way that does grave harm to patients. Continue reading “Never Events” are Pay-for-Performance in Disguise →

Physicians

Patient at Risk in EMR System

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Here is a case from the Agency for Healthcare Research and Quality (AHRQ) in which errors in an electronic medical record (EMR) led to an inaccurate diagnosis at an academic medical center in the US. It took three days for the patient’s care team to realize that the results entered into his EMR were for a biopsy they did not order of a lesion he did not have. Before the error was recognized, it had caused the patient “tremendous pain and mental anguish.”

At bottom, the error got as far as it did because of the “medical team” approach – no single person was responsible for this patient’s care. Each person relied on the (erroneous) electronic medical record for his view of the whole. Continue reading Patient at Risk in EMR System →

Physicians

More on the Debate Over EMRs

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This is from an editorial in the Washington Post:

While this sort of reform has popular support, there is little evidence that currently available computerized systems will improve care. It’s the wrong investment to make at this time.

  • After the Children’s Hospital of Pittsburgh added automated prescribing recommendations to a commercial electronic records system, the institution documented a more than threefold increase in the death rate among child patients.
  • Another leading system contributed to more than 20 different types of medical errors.
  • Studies in U.S. hospitals suggest that these systems can add a half-hour or more to a day for tasks such as electronic ordering
  • The false alerts that systems sometimes send can desensitize doctors to legitimate clinical recommendations.

Yet here is a pen and paper doctor whose office mate uses EMRs and who admits EMRs improve efficiency and quality of care.

Health Care Costs

Is Quality Competition Ethically Required?

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This is from an article in PLoS Medicine:

Doctors have an ethical obligation to tell patients if they are more likely to survive, be cured, live longer or avoid complications by going to Hospital A instead of Hospital B. And that obligation holds even if the doctor happens to work at Hospital B, and revealing the truth might mean patients will take their business someplace else.

Not everyone agrees. [link] For the government's hospital quality data, go here.

Health Care Costs

Evidence-Based Medicine

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A paper by Twila Brase, RN, PHN, president of the Minnesota-based Citizens Council on Health Care, and published by ALEC, explains the dangers of relying solely on “evidence based medicine” (EBM) to determine appropriate treatment for an individual patient. The problems are too long to list here, but they include:

  • Researcher bias when the researcher conducting the study has a preference for one form of treatment over another. Sometimes this may involve financial incentives, but that is not the only or even the major source of bias.
  • Conflicting results. This happens all the time in research. One study contradicts another, and neither may be completely accurate.
  • The expense, and therefore the rarity, of conducting randomized clinical trials. Very little medicine would be conducted if these trials controlled what could be done.
  • Comorbidities. Clinical trials focus on only one condition at a time, but few patients present with just one issue. There is a little information available about how multiple conditions and multiple treatments interact.
  • Special interest pleading. Well-organized interest groups are able to influence what topics are researched and how the research is conducted.
  • Lack of real-world testing. What works in the lab may break down on the battlefield of real life. Continue reading Evidence-Based Medicine →
Hospitals

Unsafe By Any Measure

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Although health care is one of the most heavily regulated sectors of our economy, "hospitals are rarely closed or hit with significant financial penalties for hurting patients." More often than not, the worst institutions are liberally subsidized. This is from a New York Times story on University Hospital in Syracuse:

HealthGrades, a company that rates hospitals using data from Medicare, ranks University among the least safe hospitals in the United States.

In 2006, patients at University had a 1-in-37 chance of suffering postoperative blood infections, compared with a 1-in-65 chance statewide…They had an 8.6 percent chance of dying from pneumonia, compared with a 5.5 percent chance statewide.

Yet, today, University remains under state ownership.

University Hospital received a state subsidy of $42.2 million, about $2,500 for each patient it admitted, to make up for higher wages negotiated with the hospital union.

This example is not isolated. "In 2004, New Yorkers and their insurers spent an average of $6,535 for each patient on health care, 24 percent more than the national average. Yet New Yorkers are more likely to die from chronic disease than people in any other state."

httpv://www.youtube.com/watch?v=m4Qq8UuvrUk

"Crazy"