Medical Errors: Understanding, Preventing, and Addressing the Causes
Adam Skali
I have experience on healthcare innovation and thrive in diverse, multidisciplinary teams. Together, let's unlock the future of transformative healthcare solutions.
The patient safety movement began gaining momentum worldwide in 1999 with the release of the pivotal report "To Err is Human." This document uncovered a staggering truth: annually, between 44,000 and 98,000 Americans died due to medical errors—a figure now recognized as an understatement.
Medical errors encompass a range of mistakes, including incorrect diagnoses, improper medication dosing, and delays in treatment. These errors are often underreported, partly because most research focuses on hospital settings rather than the broader healthcare system. Additionally, the long-term impacts of some errors, which may take years to manifest, complicate tracking efforts. The culture within the medical profession, which can discourage the reporting of mistakes, further exacerbates the problem. While errors might not be universally acknowledged as the third leading cause of death, their significant impact is undeniable, causing unnecessary deaths and disabilities.
Two decades after the seminal report, substantial progress has been made in understanding patient safety, although challenges in implementation persist. In 2005, the World Health Organization (WHO) initiated the Global Patient Safety Challenges, starting with hand hygiene. Subsequent challenges addressed surgical safety in 2008 and medication safety in 2017 under the title "Medication Without Harm."
Healthcare-associated infections (HAIs) represent a significant safety issue, with non-compliance in hand hygiene being a leading cause. Failure to wash hands at critical moments can result in severe patient outcomes, including death. On the latest World Hand Hygiene Day, WHO introduced a strategic guide for 2023-2030, emphasizing the importance of communication on health workers' behavior, safety climates within institutions, and the influence of hand hygiene on HAIs and antimicrobial resistance (AMR). According to WHO's 2022 report, in acute-care hospitals, seven patients in high-income countries and 15 in low- and middle-income countries acquire at least one HAI during their stay.
Medical Errors and Human Fallibility
Medical errors are a leading cause of mortality worldwide. Studies show that virtually every healthcare professional makes mistakes, often without disclosing them, leading to underreporting. This lack of transparency obscures the causes and consequences of errors, complicating efforts to address them. Errors are difficult to define and measure due to unclear definitions and lack of standardized terminology.
Despite hand hygiene's crucial role in safe healthcare delivery, compliance at the point of care remains suboptimal globally, with an average compliance rate of around 40% and about 60% in intensive care units. The disparity between higher and lower-income countries in compliance is notable.
Evidence indicates that infection prevention and control (IPC) interventions, including improved hand hygiene, can reduce HAI rates by 35% to 70%. Effective IPC not only prevents infections but also offers significant economic returns, with each dollar spent on hand hygiene saving up to $16.5 in healthcare costs. However, the application of these guidelines continues to face obstacles.
Several factors contribute to the gap between knowledge and application:
Types of Medical Errors
Economic Impact of Medical Errors
In low and middle-income countries, unsafe care results in 2.6 million deaths and 134 million adverse events annually. The high costs of essential technologies like electronic health records hinder their implementation. However, the potential for these technologies to improve patient safety is significant. The WHO estimates the global cost of medication-related harm at $42 billion annually. In the UK, the NHS faces costs of approximately ￡98 million annually from medication errors.
Improving patient safety could dramatically reduce healthcare costs, including indirect costs like lost productivity. The G20 has recognized the importance of patient safety, driven by studies from the OECD showing significant health expenditure wastage due to unsafe care. This emphasis on patient safety could lead to increased funding for healthcare technologies, enhancing the sustainability and efficiency of healthcare systems globally.
Information Asymmetry in Healthcare
Unlike traditional markets, healthcare operates with significant information asymmetry. Patients typically lack the medical knowledge of healthcare professionals, creating an imbalance. The principal-agent problem illustrates this dynamic, where healthcare providers (agents) make decisions for patients (principals). Financial incentives, resource limitations, and organizational policies can lead to decisions that are not perfectly aligned with the patient's needs.
Healthcare providers must balance providing the best possible care with managing costs. Understanding health economics, including opportunity costs, is crucial, which is why some countries have integrated health economics into medical training.
The Role of Patients in Reducing Medical Errors
Patient involvement is increasingly important in healthcare. Empowering patients and families to actively participate in their care can help address risks linked to understaffing and operational stresses. Understanding treatment and medication regimens empowers patients to spot and address errors, creating a vigilant and responsible environment.
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Collaborative Approach to Patient Safety
Patient empowerment and collaboration are crucial for transforming the healthcare system. Personalizing safety by involving patients and families in co-producing safe, high-quality care requires willingness and skill from healthcare professionals. This shift from passive to active participation is vital for achieving zero harm in healthcare.
Technological Integration
Technology plays a key role in enhancing patient safety. Closed-loop medication systems, electronic health records, and computerized physician order entry are crucial in reducing medication errors. However, financial constraints hinder the widespread adoption of these technologies. Effective integration requires a framework that includes empowered patients, a strong safety culture, and support from leadership.
Additional reads
References:
Fabes, J., Av?ar, T. S., Spiro, J., Fernandez, T., Eilers, H., Evans, S., Hessheimer, A., Lorgelly, P., & Spiro, M.; Health Economics Survey Group. (2022). Information asymmetry in hospitals: Evidence of the lack of cost awareness in clinicians. Applied Health Economics and Health Policy, 20(5), 693-706. https://doi.org/10.1007/s40258-022-00736-x
Bari A, Khan RA, Rathore AW. Medical errors; causes, consequences, emotional response and resulting behavioral change. Pak J Med Sci. 2016 May-Jun;32(3):523-8. doi: 10.12669/pjms.323.9701. PMID: 27375682; PMCID: PMC4928391.
Rodziewicz, T. L., Houseman, B., & Hipskind, J. E. (2023, May 2). Medical Error Reduction and Prevention. Retrieved from [https://www.ncbi.nlm.nih.gov/books/NBK499956/ ]
Interview of Dr.Abdulelah Alhawsawi https://www.youtube.com/watch?v=Ulh5311A4oQ
Director Growth & Strategy I C-Suite Healthcare Executive I Patient Safety Advocate I Strategic Management Consultant I Startup Mentor I Digital Health Enthusiast
3 个月Thanks Adam Skali for the article on important topic of Medication Error. Its a significant contributor to patient safety and with addition of problems of anti microbial resistance, it assumes much more significance. Despite advances in drug safety, education on prescription protocols, technology intervention, medication error continues to be leading contributor of patient harm. Imagine what we have is less accounted reported errors, and unreported errors can be much higher. All stakeholders have to come together to contribute towards this cause of reducing medication error.