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NEJM Study Shows No Decrease in Patient Harm

by Lauren M. Nelson, JD on December 2nd, 2010

In 1999, the Institute of Medicine issued a report entitled “To Err is Human: Building a Safer Health System”, which found that medical mistakes caused 98,000 deaths and more than a million injuries a year, most of which were preventable. The report was widely discussed in the media. During the past decade, hospitals across the nation implemented patient-safety measures and changed hospital operations in an effort to reduce medical errors. But according to two recently published studies, despite these efforts, patient injuries have not decreased.

On November 25, 2010, the New England Journal of Medicine published a study entitled “Temporal Trends in Rates of Patient Harm Resulting from Medical Care conducted by Stanford University School of Medicine, Harvard Medical School, and the Institute for Healthcare Improvement in which they examined randomly selected hospital admissions. The study utilized the Institute for Healthcare Improvement’s Global Trigger Tool to detect evidence of harm by reviewing patients’ medical records. The Global Trigger Tool looks for “triggers” which suggest that an error or adverse event may have occurred. The triggers include actions such as the use of an antidote for an overdose of narcotics or blood thinners. If a trigger is identified, a detailed chart review is performed to determine if an error occurred.

The study examined 2,341 randomly selected hospital admissions from ten randomly selected hospitals in North Carolina between January 2002 and December 2007. In those admissions, 588 instances of patient harm were identified. More than 80% of the harms were temporary, although half of the temporary harms increased the length of the patient’s hospital stay. According to Paul Sharek, MD, the senior study author and an associate professor of pediatrics at Stanford and a chief clinical patient safety officer at Lucile Packard Children’s Hospital, “As had been shown in several other studies, the great majority of medically induced harms in inpatient settings are minor or reversible.” However, not all harms were minor – 50 harms were classified as life-threatening, 17 events resulted in permanent harm, and 14 deaths were caused, either in whole or in part, by an error.

This study follows on the heels of a November 2010 report issued by the Inspector General of the Department of Health and Human Services, entitled Adverse Events in Hospitals: National Incidence Among Medicare Beneficiaries, which concluded that an estimated 13.5% of hospitalized Medicare beneficiaries experienced adverse events during hospital stays. This study examined nearly 1 million Medicare beneficiaries who were discharged from hospitals in October 2008. Some reviewers of the study have suggested that the Department of Health and Human Services has a vested interest in finding adverse events in order to reduce Medicare payouts.

In considering the NEJM study, it should be noted that many hospital safety initiatives, such as the widespread use of root cause analysis to investigate errors and mandatory error reporting, really did not begin until 2005. Further, one of the biggest advances in this industry, the use of more streamlined and efficient IT systems, is essentially still in its infancy. We would expect a decrease in patient injuries after there has been sufficient time to fully implement and learn from these new processes.

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