Medical errors may be the country's third-leading cause of death

Experts: It's time to stop citing 1999 estimates from IOM

Topics: Appropriateness, Quality, Performance Improvement, Medical Errors, Medication Administration, Mortality, Safety, Patient Experience

September 24, 2013

A new study in the Journal of Patient Safety estimates that preventable adverse events (PAEs) at U.S. hospitals cause as many as 440,000 patient deaths a year—a statistic that would make medical errors the third-leading cause of death in the United States.

The new study—conducted by John James of the advocacy group Patient Safety America—offers a significantly higher estimate than the oft-quoted "To Err Is Human" report from the Institute of Medicine (IOM), which estimated that there were 98,000 PAE mortalities in the country each year. The new estimate is more in line with a 2010 estimate from HHS, which determined that PAEs contributed to 180,000 patient deaths a year in Medicare beneficiaries alone.

New study findings

For the new estimate, James examined four studies on more than 4,200 patients who were hospitalized between 2002 and 2008 using the "Global Trigger Tool," which guides the search for signs of infection, injury, or medical mistakes.

James found that at least 210,000 deaths a year are due to PAEs, but believes that the true number is likely twice the figure, given the incompleteness of medical records.

Based on the new estimate, PAE deaths account for "roughly one-sixth of all deaths that occur in the United States each year," James writes in the study. According to CDC, that would mean PAEs are the third-leading cause of death, behind heart disease and cancer.

"All evidence points to the need for much more patient involvement in identifying harmful events and participating in rigorous follow-up investigations to identify root causes," James writes in his study, adding that perhaps "it is time for a national patient bill of rights for hospitalized patients."

Health experts respond to the findings

Harvard's Lucian Leape—one of the authors of the 1999 "To Err Is Human" report—told ProPublica that he has confidence in James's estimate, adding that the 98,000 IOM estimate was based on "crude" methods.

Meanwhile, David Classen—one of the developers of the Global Trigger Tool—told ProPublica that the new, updated figure is important because preventable harm leads to enormous financial costs and patient suffering. Both Leape and Classen said it is time to stop citing the 98,000 figure.

Writing about the study in Forbes this week, Leapfrog Group CEO Leah Binder criticized hospitals for failing to report PAEs accurately and failing to "put a priority on safety." She writes that Americans "haplessly pay [providers] for these errors" instead.

"It's time for Americans to make clear to hospitals that they must earn our business, and our trust, and we will not pay with our lives for their failure to act," Binder writes in Forbes.

AHA responds to the findings

American Hospital Association (AHA) spokesperson Akin Demehin said that the group will continue using the IOM estimate because it is based on a larger sampling of medical records. Demehin added that the Global Trigger Tool is not necessarily suited for making global estimates, but is instead better suited for individual hospital estimates (Allen, ProPublica, 9/20; Binder, Forbes, 9/23).

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