Hospital errors kill nearly 200,000 every year

[Illuminatus Primus]

Are you really expecting me to believe that 35000 times a surgeon actually cut someone open accidentally with the knife?

They include fucked up IVs in there, I'm sure.

[Illuminatus Primus]

Though the overwork is interesting, and I have always wondered what the rational behind it is.

You really need to get away from the libertarian literature you read. More doctors cost more for the same amount of hours. Residents are particularly bad. They had to pass a law that residents must not work more than 60 hours a week which is more than 54% of the awake week. The reason was because some resident was so exhausted he fell asleep at the wheel coming home from his work at a trauma center, hit a road-tripping family and killed them.

I really hope reforms are put in place within the health care system and the medical profession at many levels before I am an M.D., because a lot of this stuff is abominable.

[Cairber]

"HealthGrades included as mistakes failure to rescue dying patients and the death of low-risk patients from infections -- neither of which the Institute of Medicine report included."

I dont really understand the "failure to rescue dying patients" part...What were they dying from? How do they classify it as error? Doctors are human, so I would really like to know the exact classification of error (this would mean a much larger web site, but what can I say? Im not one to read a web article and believe it without a lot of proof and explaination of the study and its definitions)

we know that there were "patient-safety incidents" but not many are named...Im not even sure if the sticking part was in this category.


Its tough to sit here and argue over an article like this. Would be better to go to your local library and pick up some journals on the topic. Even better would be to see one put out by doctors and one by companies like Healthgrade, that way we could see if these "unreported incidents" actually occur or if people just assume they do. If so, what are the discrepancies in numbers? Theres just too many questions looking as this single article.

[tharkûn]

The two leading causes of "preventable deaths":

Failure to Rescue and Death in Low Mortality DRGs

Ttwo PSIs with validity concerns by the panel which authored the PSI's:

Failure to Rescue and Death in Low Mortality DRGs

Two likely PSIs to correlate extremelyt highly with the bed:nurse ratio (as opposed ANYTHING else examined):

Failure to Rescue and Death in Low Mortality DRGs

Two PSIs spaperwork sensitive PSI's (i.e. excluding DNR patients, shading of diagnosis, etc.):
Failure to Rescue and Death in Low Mortality DRGs

Two PSIs not recommended to be used and reported in this manner by the authoring commitee:
Failure to Rescue and Death in Low Mortality DRGs

Methinks the study ain't all that revolutionary.

The release of this study just happens to dovetail nicely into comments in a previous thread about how the medical industry is not harsh enough on mistakes.

The study shows quite nicely what just about everyone in medicine has known for years: we have a critical shortage of nurses and that kills people. In the majority of these "mistakes" no actual negligence nor malpractice occurred. Rather the deaths occurred because the hospital in question is understaffed, underfunded, and its medical profesionals are undertrained. The majority of the lethal "mistakes" aren't being committed by your doctors and nurses, but by the administrators who don't adequately staff and fund their wards - even then they might not always have the choice to do so (budget concerns).

When the main problem is a shortage of profesionals what exactly is there to be gained by further crackdown on those who are practicing. Is encouraging even more CYA medicine really a good thing here?

[Darth Wong]

Are you really expecting me to believe that 35000 times a surgeon actually cut someone open accidentally with the knife?

They include fucked up IVs in there, I'm sure.

Are you really expecting me to believe that every time a nurse has to stick a needle in twice for an IV, an administrative report is filed? Because their stats are all based on administrative records.

[Darth Wong]

The study shows quite nicely what just about everyone in medicine has known for years: we have a critical shortage of nurses and that kills people. In the majority of these "mistakes" no actual negligence nor malpractice occurred.

Could you please elabourate as to the kinds of incidents which would be recorded as an error, yet no actual error occurred?

When the main problem is a shortage of profesionals what exactly is there to be gained by further crackdown on those who are practicing. Is encouraging even more CYA medicine really a good thing here?

Crackdowns on mistakes will not alleviate a shortage of personnel, but that doesn't mean they're not a good idea. This is like saying that crackdowns on crime don't solve the root causes of crime; that is true, but they're still a good idea.

[Admiral Valdemar]

These are amazing figures from what I can tell. In the UK, the media is currently having a field day with the rise in cases of MRSA in hospitals. The campaign is a double-edged sword. On the one hand, it's getting hospitals to shape up on basic hygiene (you'd be amazed how many people forget to wash their hands) and thus seriously knockdown the cases of MRSA. On the other hand, it's creating yet more focused anger on the already stressed NHS with people losing any confidence in their doctors or GPs or nurses.

[tharkûn]

Could you please elabourate as to the kinds of incidents which would be recorded as an error, yet no actual error occurred?

PSI's do not actually record errors, they record statistics that hopefully correlate with errors. Some of these statistics are just tabulating the number of known errors, others, particularly the big two are not. There purpose is like criminal profiling (when done properly), not to point out that errors exist, but where it is most likely for errors to have occurred.

Death from low mortality DRGs does NOT tabulate how many people die as a result of "mistakes" when treating low mortality DRGs, but simply how far from normal a hospital diverges from normal mortality rates.

Failure to Rescue does NOT tabulate how many people die as a result of malpractice induced complications and complications treated negligently; rather it measures how far from normal complication mortality diverges.

Specific examples of included "nonmistakes":
1. A patient has a Do Not Resesicute Order on file. They go in for surgery and go into cardiac arrest. Under these circumstances the hospital could "rescue" the individual from the complication (cardiac arrest) but doesn't because the patient doesn't wish to be rescued.
2. A hospital has the minimum allowed nurse:bed ratio. As a result of this diagnosis of complications statistically takes longer (i.e. post operative infection is more quickly diagnosis with the fewer nurses per patient a hospital carries). As a result of this delay, statistically, more patients die than in a comparable hospital with a higher nurse:bed ratio.
3. A hospital has a low number of anesthesiologists. This correlates nicely with higher "Failure to Rescue", it is not that the surgeon botched the "rescue" surgery, but that the delay in getting an anesthesiologist availible to perform the surgery statistically results in higher mortality.

Most of these things come down insufficient staffing, and of the true mistakes a huge majority are due to the secondary effects of insufficient staffing. Remember most of the time your surgeon doesn't kill you with malpractice, it's your nurse.

Crackdowns on mistakes will not alleviate a shortage of personnel, but that doesn't mean they're not a good idea. This is like saying that crackdowns on crime don't solve the root causes of crime; that is true, but they're still a good idea.

When you have a shortage of cops is devoting manpower towards enforcing the litter ordinance a better idea than using that manpower to combat the rising number of violent carjackings?

A zero tolerance policy will drive people out of the profession, which exascerbates the leading cause of "preventable" death - not enough trained personnel. It is quite possible that a harsh crackdown will end up with a statistical expectation of more patients dying. Do you doubt that a crackdown on mistakes, particularly "minor" mistakes will lead to a greater shortage of trained personnel?

[Darth Wong]

PSI's do not actually record errors, they record statistics that hopefully correlate with errors.

So how unrepresentative do you think the data is? You said earlier that there was nothing new or shocking in it.

And are these statistics similar to those found in other nations, such as Canada, Britain, France, Germany, etc?

A zero tolerance policy will drive people out of the profession, which exascerbates the leading cause of "preventable" death - not enough trained personnel. It is quite possible that a harsh crackdown will end up with a statistical expectation of more patients dying. Do you doubt that a crackdown on mistakes, particularly "minor" mistakes will lead to a greater shortage of trained personnel?

So by your logic, we should ... let people make mistakes willy-nilly, for fear that the stress of being punished for mistakes would drive them out of the business? Surely there are better solutions to understaffing than that.

[tharkûn]

So how unrepresentative do you think the data is? You said earlier that there was nothing new or shocking in it.

I think the earlier study is more likely to be accurate, most of the new stuff is either reading false positives or just the fact that virtually every damn hospital in this country is hurting for trained, qualified nurses.

And are these statistics similar to those found in other nations, such as Canada, Britain, France, Germany, etc?

As far as I know Canada, Britain, France, Germany, etc. do not use the same PSI's, so our only point of comparison is going to be the known malpractice stats and those are highly specific to how you define, report, and release such information.

So by your logic, we should ... let people make mistakes willy-nilly, for fear that the stress of being punished for mistakes would drive them out of the business? Surely there are better solutions to understaffing than that.

Like most things in life, crackdowns suffer from diminishing returns. At willy-nilly patient care degrades because of negligence; at zero tolerance (at least in the current labor market) patient care degrades because of increased personnel shortages. Somewhere there is the happy middle ground where we punish agregious mistakes, but don't make punishment so hard that inevitable human mistakes depopulate the labor pool.

My preferred solution to the medical staffing problem is to take and get rid of this BS elitist medical school mentality and the obnoxiously high value of doctors (particularly compared to nurses). The bottleneck seems to be medschool admissions, I'm very much in favor of running craploads of medschool so just about anyone willing to pay to go. I expect many to crash and burn there, but there is no bloody reason that the only people who can become doctors are those who can 4 point undergrad. With a greater supply of doctors we can watch market forces drive the wages down, and with a shortage of nurses their wages go up. Hopefully this will result in a more reasonable distribution of doctors and nurses. As it stands if you have the brains, there is very little reason to be a nurse and not a doctor - the pay is better, the job load is lighter (once you are established), the respect quotient is higher, and you even have ubiquitiously less paperwork.

All that being said it will be years before something like that could be done, so in the short term I'm REALLY damn leary of anything that further tightens the nursing labor pool - that kills people.

[Illuminatus Primus]

Wow, we're on the same page. Med school reform is a desperately needed commodity.

And maybe with more doctors we wouldn't have specialists and some high-risk specialties running absurd hours with too few doctors and overworked residents. This tradition is not conducive to a healthy culture for patient care.

[CelesKnight]

Though the overwork is interesting, and I have always wondered what the rational behind it is.

I've heard it's so that one doctor/resident/nurse can monitor the same patient over the course of his treatment and follow his progress.

(Just reporting, not agreeing or disagreeing with the practivce.)

[Tsyroc]

Holy shit, Doctors are fucking lethal weapons!

It's not just the doctors.

[Patrick Degan]

I hate hospitals. I've been lucky that I've managed to avoid hospital care since having my tonsils out at age 8; though last year I had to spend more time in one than I ever wanted for some tests when I had my pinched-nerve condition that halfway paralysed my right arm and almost totally paralysed the hand. My wife works in one as a night nurse. She and the other nurses in her unit (bone marrow) are a good crew, but the "health company" which took over the management there went on a spree of cutting back the staffs in all departments including records and nursing —eliminating the assistants. I'm not at all sanguine about the prospect of ever having to wind up dependent upon a healthcare machinery where the staffs are overworked and cannot devote decent care for the patients or can't be certain they've got the correct records.

[TrailerParkJawa]

As someone who works in an understaffed customer support dept I can clearly see how quality suffers under minimal staffing conditions. But at least in my case, nobody gets hurt. I think the medical system in the US is in pretty bad shape.

[Darth Wong]

As long as we're on the subject of anecdotes, my mother quit working at the hospital shortly after somebody was basically killed by a (non-recorded) error. It was a radiation therapy overdose during chemotherapy, and no records were made of it. Officially, her condition just sharply worsened and she died of the cancer. Just one incident like that can make you very cynical about the whole thing. She now considers hospitals so scary that she doesn't want me to get surgery for my hernia, although I'm going to the Shouldice clinic which has a good reputation.

[TrailerParkJawa]

As long as we're on the subject of anecdotes, my mother quit working at the hospital shortly after somebody was basically killed by a (non-recorded) error. It was a radiation therapy overdose during chemotherapy, and no records were made of it. Officially, her condition just sharply worsened and she died of the cancer. Just one incident like that can make you very cynical about the whole thing. She now considers hospitals so scary that she doesn't want me to get surgery for my hernia, although I'm going to the Shouldice clinic which has a good reputation.

That will turn you off to working in the industry sure enough. When two of my friends needed some help with conception they ended up going to a private clinic, because the HMO they belonged to was really sloppy about the whole thing.

[Trytostaydead]

Though the overwork is interesting, and I have always wondered what the rational behind it is.

You really need to get away from the libertarian literature you read. More doctors cost more for the same amount of hours. Residents are particularly bad. They had to pass a law that residents must not work more than 60 hours a week which is more than 54% of the awake week. The reason was because some resident was so exhausted he fell asleep at the wheel coming home from his work at a trauma center, hit a road-tripping family and killed them.

I really hope reforms are put in place within the health care system and the medical profession at many levels before I am an M.D., because a lot of this stuff is abominable.

I believe it's 80 hours. And most schools/teaching-hospitals either ignore that law or find plenty of loop holes around it. Hopkins was gigged on breaking it recently. Though if you ask, most people in intensive residencies feels its a stupid-ass law. A lot of the FP/GP residents go home early anyways. The residents need to be drilled and drilled and drilled so it becomes automatic to them and they're used to standing on their feet for sometimes DAYS if necessary.

As for the article, a few points:

a) NURSES NURSES NURSES. Nurses are both the strongest and weakest links in the chain. Everyone overlooks the nurses, but life and death hangs on them, and if they fuck up it's blamed on the doctors. I have heard MANY cases of where nurses fuck up in the OR or ICU and the doctor is called onto the carpet.
b) Medicare. Medicare represents a very large elderly group. When you get into geriatrics, veterans, etc.. the initials DDx are extremely common to see on case files. Translated as: Differential Diagonsis. When you get older you get more problems, those problems share characteristics with many others or even then its hard to identify what.
c) Following with A, hospitals in general. Paperwork fuckups, infections, etc.

[Edi]

I've related this before, but my friend's grandfather died during a routine and supposedly completely safe operation during a hospital visit that basically amounted to a medical checkup. He had some trouble with his kidneys or similar and had to have dialysis done, and he was supposed to be given some of the saline solution with the same osmotic properties as blood to keep his blood pressure normal while he was connected to the machine. The nurse accidentally connected a bottle of pure alcohol into the drip and he died. The bottles weren't properly labeled.

This is the kind of shit that can happen by accident when people are overworked or careless. We have a good system of cracking down on things like this and consequences of mistakes can be pretty harsh on doctors, so they are careful about them.

Edi

[BlkbrryTheGreat]

As long as we're on the subject of anecdotes, my mother quit working at the hospital shortly after somebody was basically killed by a (non-recorded) error. It was a radiation therapy overdose during chemotherapy, and no records were made of it. Officially, her condition just sharply worsened and she died of the cancer. Just one incident like that can make you very cynical about the whole thing. She now considers hospitals so scary that she doesn't want me to get surgery for my hernia, although I'm going to the Shouldice clinic which has a good reputation.

You know, for a man who's constantly singing praises about the Canadian Healthcare system, you sure do have alot of horror stories about it.

[Darth Wong]

As long as we're on the subject of anecdotes, my mother quit working at the hospital shortly after somebody was basically killed by a (non-recorded) error. It was a radiation therapy overdose during chemotherapy, and no records were made of it. Officially, her condition just sharply worsened and she died of the cancer. Just one incident like that can make you very cynical about the whole thing. She now considers hospitals so scary that she doesn't want me to get surgery for my hernia, although I'm going to the Shouldice clinic which has a good reputation.

You know, for a man who's constantly singing praises about the Canadian Healthcare system, you sure do have alot of horror stories about it.

Nice attempt at a thread hijack, asshole. There's no indication that the problem is significantly different between the Canadian and American systems, hence it's not relevant to a comparison of the two.

[BlkbrryTheGreat]

As long as we're on the subject of anecdotes, my mother quit working at the hospital shortly after somebody was basically killed by a (non-recorded) error. It was a radiation therapy overdose during chemotherapy, and no records were made of it. Officially, her condition just sharply worsened and she died of the cancer. Just one incident like that can make you very cynical about the whole thing. She now considers hospitals so scary that she doesn't want me to get surgery for my hernia, although I'm going to the Shouldice clinic which has a good reputation.

You know, for a man who's constantly singing praises about the Canadian Healthcare system, you sure do have alot of horror stories about it.

Nice attempt at a thread hijack, asshole. There's no indication that the problem is significantly different between the Canadian and American systems, hence it's not relevant to a comparison of the two.

I'll wait for the Canadian accident report rate to see if thats the case.... oh wait, thats right- they don't seem to report them in Canada.

[Darth Wong]

I'll wait for the Canadian accident report rate to see if thats the case.... oh wait, thats right- they don't seem to report them in Canada.

Nice speculation without a shred of evidence, as usual for an idiot like you. I had no idea that the Americans had developed a method of ensuring that it's impossible to cover anything up in a hospital. And it's too bad we Canadians mysteriously live longer with our inferior health-care system, eh? Or didn't you know that according to WHO, Canadians live more than 2 years longer than Americans on average?

[Mayabird]

a) NURSES NURSES NURSES. Nurses are both the strongest and weakest links in the chain. Everyone overlooks the nurses, but life and death hangs on them, and if they fuck up it's blamed on the doctors. I have heard MANY cases of where nurses fuck up in the OR or ICU and the doctor is called onto the carpet.

The problems with nurses are twofold: firstly, there aren't nearly enough, and there aren't any good ways to make up the shortage without massively increasing medical costs (and of course that's a big no-no.) Nurses are underpaid and underappreciated, so not many people go into it, and of those a lot of the good ones are driven away because they can't make enough (and could easily get more survivable wages in some other less stressful medical field) while also being overworked. To cut costs, a lot of hospitals, even the one in my podunk hometown, are recruiting foreign nurses from Nigeria and the Phillipines. A lot of them (not all, but a frighteningly large number) do not have a firm enough grasp of English (spoken or written) but because a lot of hospitals are just trying to get warm bodies they don't care, so errors start to pile up. Add that to them being given the responsibility of too many patients (five or six at a time IIRC is the optimal number, but seven or eight can be done in a pinch, while many nurses regularly are supposed to care for more patients than that, and they can't do a good job with that many people).

So what happens is you have overworked overstressed nurses who may not be the highest quality who aren't for a combination of reasons giving good basic care to patients, but those little things that they fail to do can end up fatal (a wrong medication, forgetting that a patient has a food allergy, not having time to check in on a patient to make sure they're doing alright, etc.).

It's not the whole story, but no one else is talking about it.

[Howedar]

I'll wait for the Canadian accident report rate to see if thats the case.... oh wait, thats right- they don't seem to report them in Canada.

Textbook argumentum ad ignorantiam.