Medical error

Medical errors are the preventable incidents which harm patients. Although medical malpractice ordinarily involves both error and poor patient outcome, medical errors and malpractice are not the same. In medical malpractice, there is always a component of negligence or failure to meet an acceptable standard of care on the part of the caregiver. In theory, the incidence of medical malpractice can be reduced to zero. Errors, on the other hand, are made by every health care worker in every hospital and health care facility. In fact, errors are made by the best trained and most intelligent physicians, nurses, and pharmacists even when diigently following the highest standards of care. The reason is straightforward: in any human system, error can occur and therefore, eventually, does occur. The incidence of error in medical care can be reduced, but never totally eliminated.

In one sense, however, there is a difference between human error on the part of those involved in medical care and the term 'medical error'. That difference is a matter of correction before an error results in harm. Medical errors are actions, or omissions, on the part of physicians, nurses and other caregivers that lead to a suboptimal result for the patient. In other words, an error that is recognized immediately and fully remedied does not go on to have untoward consequences. There are some errors that, once committed, cause irreparable harm, like sudden death or brain damage - but these are the great minority of actions. Ordinarily, a bad result occurs as the result of more than one error, an initial mistake and at least one subsequent failure to recognize and counter it.

"In 2001, the U.S. Institute of Medicine estimated the risks of medical error-related deaths in the United States to be 44,000–98,000 deaths per year, letting aside other serious adverse events". (reference for quote:Assadian O. Toma CD. Rowley SD. Implications of staffing ratios and workload limitations on healthcare-associated infections and the quality of patient care. Critical Care Medicine. 35(1):296-8, 2007 Jan. UI: 17197771)

On-going strategies for reduction of medical error

Within the health sciences, there have been varying approaches to reducing medical errors.

Adaptation of a "pilot's chectlist" to prepare for take-off and landing has been tested for use for usefulness in preparation for the performance of Cesarean delivery under general anesthesia.

Improvement of medical personel.

Reduction of duty hours

Myers JS. Bellini LM. Morris JB. Graham D. Katz J. Potts JR. Weiner C. Volpp KG. Internal medicine and general surgery residents' attitudes about the ACGME duty hours regulations: a multicenter study.[see comment]. [Journal Article. Multicenter Study. Research Support, U.S. Gov't, Non-P.H.S.] Academic Medicine. 81(12):1052-8, 2006 Dec. UI: 17122468

oversight of professional conduct

Institute for Healthcare Improvement

The Institute for Healthcare Improvement (IHI) defines medical harm as "unintended physical injury resulting from or contributed to by medical care (including the absence of indicated medical treatment) that requires additional monitoring, treatment or hospitalization, or results in death." IHI is an organization which works with healthcare providers in the U.S. to reduce medical errors. It is estimated by IHI that as many as 15 million incidents of medical error occur annually in the United States. Previously, IHI initiated the 100,000 Lives Campaign. That campaign, participated in by 3,200 hospitals, is estimated to have reduced deaths of patients in hospitals by 122,000 in 18 months. The campaign focused on 6 "interventions" which had been identified as likely to reduce medical error:

1. Deploy Rapid Response Teams… at the first sign of patient decline – and before a catastrophic cardiac or respiratory event.
2. Deliver reliable, evidence-based care for acute myocardial infarction…to prevent deaths from heart attack.
3. Prevent adverse drug events…by reconciling patient medications at every transition point in care.
4. Prevent central line infections…by implementing a series of interdependent, scientifically grounded steps.
5. Prevent surgical site infections…by following a series of steps, including reliable, timely administration of correct perioperative antibiotics.
6. Prevent ventilator-associated pneumonia…by implementing a series of interdependent, scientifically grounded steps.

IHI's second campaign, the 5 Million Lives Campaign, challenges 4,000 hospitals to adopt at least one of twelve interventions: the six original interventions and six more:

1. Prevent methicillin-resistant Staphylococcus aureus (MRSA) infection...by reliably implementing scientifically proven infection control practices throughout the hospital
2. Reduce harm from high-alert medications...starting with a focus on anticoagulants, sedatives, narcotics, and insulin
3. Reduce surgical complications...by reliably implementing the changes in care recommended by the Surgical Care Improvement Project (SCIP)
4. Prevent pressure ulcers...by reliably using science-based guidelines for prevention of this serious and common complication
5. Deliver reliable, evidence-based care for congestive heart failure…to reduce readmissions
6. Get boards on board…by defining and spreading new and leveraged processes for hospital boards of directors, so that they can become far more effective in accelerating the improvement of care

The goal is encourage hospitals to improve their procedure enough to eliminate five million incidents of medical harm during a 24-month period, ending Dec. 9, 2008.

The Patient Advocate

Reduction of medical error can be effected on the patient side as well as on the side of the care giver, but only with vigilence on the part of the patient him or herself, or the patient's advocate.

Notes

References

• "IHI Launches National Initiative to Reduce Medical Harm in U.S. Hospitals, Builds on 100,000 Lives Campaign"
• The Wikipedia article "Medical error" was consulted during the writing of this article and certain materials referenced in it were used.

Further Reading

Atul Gawande. Complications. A Surgeon's Notes on an Imperfect Science. ISBN 0-312-42170-2