In the midst of tort reform debates that consume our news and politics, we often forget to consider its equalizer: patient safety. Tort reform is regularly promoted as the solution to lowering high health care costs in the United States, however, old and new studies show that promoting patient safety may have a bigger effect on lowering health care costs. Most importantly, patient safety actually addresses the patient side of health care rather than de-humanizing the argument to be one of numbers.
Over a decade ago, the Institute of Medicine, a non-partisan entity that advises the government on health matters, released a study finding that preventable medical errors were responsible for as many as 98,000 deaths and more than one million injuries each year. This loss of human life is equivalent to two 737 planes crashing every day, making preventable medical errors the sixth leading cause of death in America.
Apart from the loss of human life, upon which no price tag can be placed, medical errors are estimated to result in total costs of between $17 billion and $29 billion per year in hospitals nationwide. By now, the cost of preventable medical errors to American health care consumers may be more than $319 billion.
This report found that medical errors are commonly caused by faulty systems, processes and conditions that lead people to make mistakes or fail to prevent them. In response, the Institute of Medicine called for a national effort to make health care safer, and laid out a comprehensive strategy by which government, health care providers, industry and consumers could reduce preventable medical errors. The institute set a minimum goal of a 50 percent reduction in errors over the next five years.
In the wake of this report, extensive efforts have been undertaken to improve patient safety, make hospitals less hazardous to their patients and thus reduce health care costs. Recent publications, however, question whether any progress in patient safety has been made.
Journal Finds No Progress
A study led by a team of researchers from Harvard recently found that in 10 North Carolina hospitals, harm to patients was common and the number of medical errors did not decrease over time. As noted by The New York Times, this study was one of the “most rigorous efforts to collect data about patient safety since a landmark report in 1999 found that medical mistakes caused as many as 98,000 deaths and more than one million injuries a year in the United States.”
As part of the study, 14 hospitals in North Carolina were asked to participate, with 10 of the 14 being selected for inclusion. From 2002 to 2007, 100 admissions records from each hospital were randomly selected for review every quarter. After reviewing nearly 2,400 adult admissions records, the researchers found that 18 percent of patients were injured during their hospital stay (some patients were injured more than once in a single visit) and 63.1 percent of the injuries were judged to be preventable. The study noted that some common problems were temporary and treatable, including complications from procedures or drugs and hospital-acquired infections, but some problems were serious, and a few — 2.4 percent — caused or contributed to a patient’s death.
North Carolina was selected for the study because of the state’s “high level of engagement in efforts to improve patient safety” and its noted engagement in the Institute for Healthcare Improvement’s harm-reduction campaigns. Despite concerted efforts by North Carolina’s hospitals, harms remained common. Dr. Christopher P. Landrigan, the lead author of the study and an assistant professor at Harvard Medical School, was quoted in The New York Times stating, “It is unlikely that other regions of the country have fared better.”
This comprehensive study shows that despite efforts of hospitals and doctors to make patient safety a priority, the rate of mistakes have not dropped. Although not expressly discussed in the article, the treatment required to address these medical errors undoubtedly costs millions in health care costs.
As stated by the authors, “Further efforts are needed to translate effective safety interventions into routine practice and to monitor health care safety [and costs] over time.”
Preventable Errors for Medicare Beneficiaries Cost Billions
Like the Harvard study, the inspector general of the Department of Health and Human Services recently issued a government report finding a similarly high rate of hospital errors. Based on a nationally representative random sample of all Medicare beneficiaries discharged during October 2008, an estimated 13.5 percent of hospitalized Medicare beneficiaries experienced adverse events during their hospital stays.
In other words, about one in seven — or 134, 000 of the nearly 1 million Medicare beneficiaries discharged from hospitals in October 2008 — experienced an adverse event that met at least one of the department’s criteria.
Physician reviewers determined that 44 percent of adverse and temporary harm events were clearly or likely preventable. And in 1.5 percent of the patients — 15,000 in the month studied — medical mistakes contributed to their deaths.
The report said the extra treatment required as a result of the injuries could cost Medicare several billion dollars a year.
Two Examples of Preventable Errors
The development of infections during and after surgical procedures imposes a significant clinical burden on patients and a financial burden on the United States population. Two recently published studies discuss factors that compromise patient safety and increase health costs; factors that could ultimately be avoided.
The Journal of American College of Surgeons published an article finding that delay in elective surgery was associated with a significant increase in infectious complications, mortality and significantly higher hospital costs. A sample of 87,318 patients undergoing either CABG (coronary artery bypass graft) procedures, colon resections or lung resections from 2003 through 2007 were queried as to who developed postoperative infectious complications when the time of their elective surgery was less than one day from admission, two to five days from admission, and six to 10 days from admission. The risk of infection more than tripled for CABG procedures performed within from zero to one day of admission to surgeries performed six to 10 days from admission. The risk of infection for colon resection and lung resection patients more than doubled over this time period.
This study directly supports the prevention of in-hospital delay of elective surgery in order to decrease infectious complications after elective surgery and to ultimately decrease hospital costs.
A study conducted by the Dartmouth-Hitchcock Medical Center discussed how the anesthesia environment poses a risk factor to patient safety. The study challenged a commonly held belief by physicians that they play little or no role in bacterial transmission and support initiatives to improve intra-operative hand hygiene of anesthesia providers to prevent surgical infections.
Real Life Victims
The studies above underscore the fact that medical errors are costly, preventable and are not going away. This is reason alone to demand higher standards of patient safety. But the stories of those who are victims of preventable medical errors are the most compelling reason to fight for increased patient safety.
A 52-year-old father to three daughters goes in for a routine out-patient procedure to have a polyp removed from his colon. The surgeon searches for the polyp on the wrong side of the patient’s colon for three hours before realizing the mistake. After seven hours of surgery, the patient is left with a huge open wound and develops an infection. An otherwise healthy man is dead within 10 days.
A 36-year-old man falls from an elevated scaffold and breaks bones in his cervical, thoracic and lumbar spine. After eight days of being in the hospital, he begins to lose feeling in his legs. The loss of sensation worsens, but the hospital staff fails to respond to the patient’s persistent complaints. This man is now a paraplegic and will require a lifetime of assisted living.
More than 10 years after the Institute of Medicine reported that 98,000 patients were injured from preventable medical errors each year, we still do not find ourselves closer reducing these numbers.
Adrianne Walvoord is an associate at Anapol Schwartz Weiss Cohan Feldman & Smalley, handling pharmaceutical and medical device mass tort litigation and medical malpractice litigation. She practices in federal court as well Pennsylvania and New Jersey state courts. She also represents juveniles affected by the Luzerne County Juvenile Detention Center scandal. She can be contacted at email@example.com.