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By Cynthia Ronzio, Public Health Consultant

The British Medical Journal (BMJ) recently published a highly controversial and alarming study that claims that medical errors are the third leading cause of death in the US.[1]  The authors used crude statistics (for example, they do not describe their method of extrapolation nor is there mention of weights, case-mix adjustments, or age-adjustments, all of which directly affect mortality rates) but the main messages of the article should not be ignored. The medical error rate in the US is of serious concern and the voluntary and unregulated error reporting system fails patients.

“Medical error” is defined by the Institute of Medicine (IOM) as "the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim."[2]  “Adverse events” is a more inclusive term and refers to harm experienced by the patient due to medical care (such as a fall in a hospital room). Regardless of the definition used, the BMJ study is the first to name medical errors as a leading cause of death in the US, as if it were a disease.

The authors relied on previously published data because the US still does not have a systematic, verifiable, and unbiased means of collecting data on medical errors. Research and governmental reports on US medical errors and adverse reports consistently demonstrate that adverse events are under-reported and that they contribute to tens of thousands of preventable deaths per year. For example, in a study of a random selection of hospitalizations in three hospitals, a record review detected 354 adverse events.  The hospitals’ voluntary adverse reporting system reported only four of these events.[3]

A previous study of Medicare beneficiaries conducted by the Office of the Inspector General of HHS estimated that 13% of Medicare beneficiary hospitalizations had adverse events that seriously harmed the patients.[4]  This 13% adverse event rate includes patient fatalities. 1.5% of Medicare beneficiary hospitalizations led to the patient's death; in other words, an estimated 180,000 Medicare patient deaths in one year were due to adverse events that occurred during an inpatient stay.

To ensure quality medical care for Medicare beneficiaries, CMS and advocates must hold physicians and institutions accountable for patient harm. As a nation, we must continue research on systems that reduce medical errors and adverse events, and insure these systems are put into practice in every US hospital.

[1] Makary Martin A, Daniel Michael. Medical error – the third leading cause of death in the US BMJ 2016; 353 :i2139
[2] Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health system. National Academies Press, 1999
[3] Classen D, Resar R, Griffin F, et al. Global “trigger tool” shows that adverse events in hospitals may be ten times greater than previously measured. Health Aff 2011;30:581-9doi:10.1377/hlthaff.2011.0190
[4] Department of Health and Human Services. Adverse events in hospitals: national incidence among Medicare beneficiaries. 2010.


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