Number of deaths caused by medical errors under dispute

But the medical community agrees that even one mistake is too many.

By Damon Adams, amednews staff. Aug. 20, 2001.

Paula Griswold doesn't want the patient safety movement to get bogged down in a numbers game.

A 1999 Institute of Medicine report said from 44,000 to 98,000 Americans die each year from medical errors in hospitals. Now a new study published in the July 25 issue of the Journal of the American Medical Association says that number was overestimated and offers an error rate that places the death toll much lower -- at between 5,000 and 15,000.

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Griswold, executive director of the Massachusetts Coalition for the Prevention of Medical Errors, is among the health care leaders concerned that the new figure may hinder efforts to reduce medical mistakes by making the problem seem less drastic than the IOM report, "To Err is Human: Building a Safer Health System," indicated.

They say physicians and other health professionals should focus on advancing safety improvements -- not debating whose numbers are right.

"If it has us back to talking about the numbers, that's a shame," Griswold said. "I don't think it's going to shift the momentum. In a way, it's a ... chance to emphasize that the bottom line is let's spend our energy and resources on making improvements."

When the IOM report was released, the error estimates sparked public interest but drew criticism from some in the medical community who said the numbers were too high. Despite the controversy, most health care leaders agreed that there was a dire problem that needed to be remedied. Hospitals and health plans heeded the IOM's urgent call to begin launching safety programs and implementing medication safety practices.

The new JAMA study said previous studies overestimated the number of deaths linked to errors. In their study, which examined the reliability of physician-reviewer ratings of medical errors, Rodney Hayward, MD, and Timothy Hofer, MD, had 14 internists review 111 deaths at seven Veterans Affairs medical centers from 1995-1996.

Among the findings: 22.7% of deaths might have been prevented if the patient received optimal care, and only 0.5% who died would have lived three months or more in good health with optimal care.

Not about numbers

Lucian Leape, MD, a medical error expert who co-authored the IOM report, lashed out at the JAMA study, saying it relied on "tortured statistics" and used too small of a sample. He said it sent the wrong message, focusing on mortality and life expectancy rather than on finding system failures and fixing them. Yet he insisted that debating numbers is unproductive.

"Instead of counting accidents, errors or deaths, what we should do is look at specific problems," said Dr. Leape, a Harvard School of Public Health adjunct professor of health policy. "Most of us would like to get away from the numbers game and get our systems improved."

Dr. Leape said health care professionals have told him they will not lessen work to reduce errors in hospitals as a result of the JAMA study.

"The safety movement is not in any trouble. I don't think any paper is going to interfere with it," he said.

AMA Secretary-Treasurer Donald J. Palmisano, MD, agreed.

"What we want to do is focus on the patient and make the [health care] system as safe as possible," said Dr. Palmisano, a New Orleans surgeon. "We say that one error is one error too many."

Dr. Hayward, JAMA study co-author, said he understands concerns that his findings might derail patient safety efforts. But he said that was not the study's intent.

"Our study confirms that errors are an important problem, and to suggest that our study shows otherwise would be wrong. We are in agreement with the call to action voiced in the IOM report and the patient safety movement," said Dr. Hayward, director of the VA Center for Practice Management and Outcomes Research in Ann Arbor, Mich.

No expected fallout

The Leapfrog Group, a consortium of about 80 Fortune 500 companies and other large health care purchasers launched after the IOM report, is using incentives to push for safety advances. That won't stop because of the JAMA study.

"It's not going to change how big we think the problem is," said Suzanne Delbanco, PhD, Leapfrog's executive director.

Health plans are not expected to back off their initiatives, which include giving physicians handheld devices for patient information and electronic prescribing.

"Plans are going to continue their efforts," said Charles M. Cutler, MD, chief medical officer of the American Assn. of Health Plans. "I haven't heard people say, 'Gee, now let's forget patient safety.' I don't think that's appropriate or responsible."

ADDITIONAL INFORMATION:

Weblink

JAMA abstract, "Estimating Hospital Deaths Due to Medical Errors," July 25 (vol. 286, issue 4) (http://jama.ama-assn.org/issues/v286n4/rfull/joc02235.html#abstract)

IOM report, "To Err Is Human: Building a Safer Health System" (http://www.nap.edu/books/0309068371/html/)

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