Little Improvement Seen in Medical Errors

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Five years after a major report about an epidemic of medical errors in the U.S. health care system, little progress has been made to make medical care safer, experts say.

Observers site a lack of money and political will needed to fund safety research and implement safeguards in hospitals and doctors’ offices throughout the nation. But they also point to a resistant medical culture in which doctors still balk at efforts to record medical errors and participate in systematic steps to prevent them.

The Institute of Medicine issued a report in November 1999 warning that lax and sometimes nonexistent safety practices were causing widespread medical errors in doctors’ offices, pharmacies, intensive care units, and operating rooms throughout the country. The report — believed to be among the most widely read in the institute’s history — claimed that between 44,000 and 98,000 Americans die each year because of preventable medical mistakes.

The numbers echoed as lawmakers vowed a national effort to reduce errors. Media reports of glaring medical mistakes — such as removing the wrong kidney from a donor or amputating the wrong leg — grabbed headlines.

But five years later, there is little evidence to show that the report’s recommendations are being systematically implemented or that harm caused by dangerous errors has dropped.

“Let’s not kid ourselves about what’s happening. We don’t have a national effort for patient safety,” says Lucian L. Leape, MD, a professor of health policy at Harvard and a member of the 1999 IOM report committee.

Leape says scant progress has been made on several of the report’s key recommendations, including finding a way to change hospital cultures that discourages medical error reporting and promoting team training where doctors, nurses, and others learn to work efficiently as a unit.

He also points to a lack of research money. The Agency for Healthcare Research and Quality, charged with funding medical error studies, received $60 million this year compared with $27 billion that went to the National Institutes of Health.

Advocates complain that despite the initial outcry about medical error injuries and deaths, lawmakers and health care organizations have felt little pressure to change.

“This is a huge killer, and if we called it anything else, like SARS, with this large level of mortality, we’d have a huge national effort,” Arthur Levin, director of the Center for Medical Consumers, says in an interview.

Robert M. Wachter, MD, another member of the 1999 IOM committee, told a conference commemorating the report that evidence that doctors’ attitudes about patient safety — or that safety itself has improved — are “not striking.”

Several states now have laws mandating that hospitals report medical errors and “near misses” that have the potential to harm patients. But many medical errors are as much the fault of antiquated record keeping and prescribing systems in overcrowded hospitals as they are doctor or nurse error.

“There are a lot of reports. They sit on a shelf somewhere and have not been translated into action,” says Wachter, associate chairman of the department of medicine at the University of California, San Francisco.

Allan Vaida, director of the Institute for Safe Medication Practices, says some progress has been made since 1999. Federal regulators and drugmakers are now much quicker to respond to alerts that a drug’s name or packaging could be leading to confusion, he notes.

“People are listening,” Vaida says.

But policy makers still struggle for ways to hold incompetent health care providers accountable without allowing the threat of punishment to stifle medical error reporting.

Doctors Resisting?

Doctors may also be resisting recommendations to promote team-style training where doctors, nurses, and other personnel work more like a unit to reduce medical errors. A similar system is routinely used by airline pilots and is credited with providing checks and balances that help cut cockpit mistakes.

Wachter pointed to a survey in which five times as many surgeons than pilots said that their decisions should never be questioned. And while team training is done in isolated health systems and hospitals, it is not widespread, he says.

Carol Haraden, PhD, who heads the Institute for Healthcare Improvement in Boston, says that doctors, policy makers, and hospitals have been slow to respond because of a lack of outcry from the public. “There has to be some sense of obligation and moral outrage about the outcome, and I don’t think we feel that yet.”

By Todd Zwillich, reviewed by Brunilda Nazario, MD

SOURCES: Lucian L. Leape, MD, professor of health policy, Harvard University School of Medicine. Arthur Levin, director, Center for Medical Consumers. Robert M. Wachter, MD, associate chairman, department of medicine, University of California, San Francisco. Carol Haraden, PhD, director, Institute for Healthcare Improvement