Medical errors in the USA: human or systemic?

摘要

The US Institute of Medicine's landmark 1999 report, To Err is Human: Building a Safer Health System, estimated that avoidable medical errors contributed annually to 44000-98000 deaths in US hospitals. Hospital-based errors were reported as the eighth leading cause of death nationwide, ahead of breast cancer, AIDS, and motor-vehicle accidents. The report put medical errors under the national spotlight. Over 10 years later, the problem of medical errors remains and might even have escalated. In the April issue of Health Affairs, David Classen reports that as many as one in three patients in the USA encounters a medical error during a hospital stay. The most common are medication errors, followed by surgical errors, procedure errors, and nosocomial infections. The study also compared three different methods of detecting adverse events: voluntary reporting of sentinel events (as mandated by state and other oversight bodies), the commonly used Agency for Healthcare Research and Quality's Patient Safety Indicators (which rely on automated review of discharge codes to detect adverse events), and the Global Trigger Tool pioneered by the Institute for Healthcare Improvement (which uses specific methods for reviewing medical charts that lead to further investigation into whether an adverse event occurred and how severe it was). The chart-review methodology picked up at least ten times more confirmed serious event cases (90% of 393) than did the other two methods (10% or 39 events). This finding suggests that the two currently used methods for detecting medical errors in the USA are unreliable, underestimate the real burden, and also risk misdirection of present efforts to improve patient safety.