Patient safety is not improving: studies

Well, this is discouraging. Two recent studies indicate that, after a decade-long, nationwide campaign to make hospitals safer for patients, essentially no progress has been made.

A patient checking into a hospital today appears to face at least a one-in-four chance of coming to some degree of harm there.

A study published this week in the New England Journal of Medicine looked at the records of 2,341 patients discharged from 10 randomly selected hospitals in North Carolina, which was chosen because of that state's "high level of engagement in efforts to improve patient safety."

The study took place between January 2002 and December 2007. What it found was, in short, that "harm to patients resulting from medical care was common in North Carolina, and the rate of harm did not appear to decrease significantly during a 6-year period ending in December 2007, despite substantial national attention and allocation of resources to improve the safety of care," the report stated.

A total of 588 patients were injured — 25.1 percent of study subjects. Harm was caused by, in declining numbers, procedures, drugs, hospital-based infections, other therapies, tests, falls and other causes, the study found. Sixty-three percent of these injuries were deemed to have been preventable. Nine preventable errors resulted in death, and 13 in permanent damage.

In addition, a report from the U.S. Dept. of Health and Human Services released earlier this month documented the experiences of 780 randomly selected Medicare patients discharged from various hospitals in October of 2008.

About one in seven of these patients experienced "adverse events" — serious harm that comes to a patient as a result of medical care.

A second group of about the same size in the HHS study suffered "temporary harm," a transient injury like bedsores (here called "pressure ulcers") for example, or hypoglycemia. Twenty-seven percent of temporary harm events were caused by drugs.

Twenty-eight percent of patients who experienced more serious "adverse events" also suffered some temporary harm during the same hospital stay.

About 44 percent of all these events — adverse events and temporary harm — in the HHS study were deemed preventable — the result of errors, substandard care, or insufficient monitoring.

In 1999, the independent, not-for-profit Institute of Medicine published a report on hospital safety, "To Err is Human," which caused a sensation and produced a massive effort to improve protocols at hospitals across the country. The goal was to decrease errors by 50 percent over a five-year period.

"To Err is Human" asserted that as many as 98,000 patients die in hospitals each year because of medical error.

Commenting on the two discouraging new studies, the authors of the NEJM report on patient safety in North Carolina write, "All the findings about extent of harm should increase our commitment to prevent it."

Medicine too complex to be error-free

I notice that the American College of Obstetricians and Gynecologists is gearing up for its annual clinical meeting May 15 through May 19 in San Francisco.

The 2009 annual meeting was in Chicago, and I attended as many sessions as I could -- I don't want my ideas about what is going on in obstetrics to stop with my own birth experiences. (Sadly, I won't be able to attend the San Francisco meeting.)

I learned a lot last May, but one thing stayed with me in particular, Dr. Robert Wachter's keynote address.

Dr. Wachter,  chief of the medical service at the University of California at San Franciso, among other titles, is one of the founders of the hospitalist movement, and an expert in patient safety.

He spoke about efforts to improve safety since 1999, when the Institute of Medicine released its landmark report,To Err Is Human, which revealed that as many as 98,000 people were dying from medical mistakes every year.

Dr. Wachter's message is important for the birth story because obstetricians are the doctors most often sued for malpractice. A 2003 ACOG survey showed that 76 percent of OB-GYNs have been sued at least once.

Many of them would say that if anything ever goes wrong with a birth, they are sued whether the mishap was their fault or not. Dr. Wachter agreed that "the blame game" is "not productive."

He said, "Medicine is too complex to be error free." Some other complex industries have better safety records, though, he said, often because they have developed "systems thinking," standardizing procedures and accepting that some mistakes are a natural part of the process.