Who takes the blame for medical errors?

Headnote

Mistakes are not always the fault of an individual-sometimes, the system is the problem. An expert takes a hard look at what should be done.

According to a 2000 report from the Institute of Medicine (IOM), as many as 98,000 hospitalized patients die each year as a result of medical errors.1 Additionally, medical errors cause physical and psychological suffering. In economic terms, the estimated total costs of medical errors approach $29 billion per year. Further, medical errors erode public confidence in the health-care system and decrease worker productivity and school attendance.

An error may be defined as "the failure of a planned action to be completed as intended, or the use of a wrong plan to achieve an aim."1 In contrast, an adverse event is defined as "an injury resulting from a medical intervention."1 Some errors result in injury, but not all errors cause adverse events. Those that do not are referred to as near misses. Conversely, some (but not all) injuries sustained during medical interventions (adverse events) result from medical errors. Because the practice of medicine is a hazardous activity, sometimes patients are injured despite the delivery of appropriate medical care.

Why is the error rate so high?

A seminal article in The Journal of the American Medical Association2 cites a study of errors in an intensive care unit that revealed an average of 1.7 errors per day per patient, of which 29% had the potential for serious or fatal injury. The patients in the study were the recipients of 178 "activities" per day, so hospital personnel were functioning at 99% efficiency. While that sounds positive, the author points out, "[A] 1% failure rate is substantially higher than is tolerated in...[other] hazardous fields such as aviation and nuclear power...[E]ven 99.9% may not be good enough."2

The author suggests that medicine could learn a great deal from the aviation industry, which has posted an exemplary safety record since the 1970s. Specifically, medicine should accept that errors are inevitable and design systems (employing automation and redundancy) to absorb those errors, employ checklists and standardization of procedures, and endeavor to institutionalize safety.

Types of medical errors

There are a number of different types of medical errors, but this article will focus on medication and surgical errors.