It is often difficult to quantify the amount of medical malpractice. Estimates vary widely and are frequently criticized as not being based on actual facts. In this post I am going to discuss a study which recently appeared in BMJ, formerly known as the British Medical Journal. The study found a high incidence of serious, preventable, adverse events among patients admitted for surgery to hospitals in Massachusetts in 2018. The actual numbers are startling and scary.
In the 1991, the Harvard Medical Study appeared in the prestigious New England Journal of Medicine. It studied the incidence of preventable adverse events occurring during hospitalizations. Half of the hospitalizations studied were for surgery. It was a shock to the medical profession to discover how many preventable adverse events there were. The Study prompted major reforms to make hospitalizations and surgeries safer. Checklists were introduced, new protocols for post-surgical recovery were created, many surgeries changed to new technologies to minimize the trauma to the patient. The purpose of the recent study was to see how much progress had actually been made.
The study was well-constructed. A team of doctors and nurses reviewed the records of 1009 patients randomly selected out of a total of 64,121 patients admitted for surgeries at 11 hospitals in Massachusetts in 2018. The patient records came from both large and small hospitals. All patients were 18 or older.
A team of nine experienced nurses reviewed the records initially and flagged incidents which were or might be adverse. For the purposes of the study, an adverse event was defined as unintended physical injury resulting from or contributed to by medical care that required additional monitoring, treatment or hospital admission or which caused death. After the nurses flagged incidents of possible adverse events, a team of physicians reviewed the records and either agreed or disagreed. If the doctors agreed that the event was an adverse event, they categorized its severity. The classification categories were: significant, serious, life-threatening, or fatal. Adverse events in the last three categories were deemed to be major. The doctors also determined if the event was preventable.
The teams found at least one adverse event in 38% of the admissions. Some had multiple adverse events. Of those admissions with one or more adverse events, almost half of the adverse events were major, meaning there was serious harm to the patient, resulting in either substantial additional treatment or prolonged recovery, or a life-threatening situation, or death. Significantly, over half of the adverse events were potentially preventable and a quarter were definitely preventable. The highest rates of adverse events occurred in connection with cardiovascular or thoracic surgery. The adverse events were not confined to the operating room, but took place throughout the hospital and throughout the admission.
Let that sink in for a moment. If you are admitted to the hospital for surgery, you have an almost 4 in 10 chance of experiencing an adverse event. If you experience an adverse event, there is a 50% chance that it will be a major one, which may even cause your death. Not only that but half the time, the adverse event will be likely or definitely preventable.
This was a thorough, well-constructed study and its results are highly reliable. The authors suggest that earlier studies, which found lower rates of adverse events, may have been affected by less accurate record keeping than is available today with electronic medical records.
Despite the fact that we have known for decades about the problem of significant, preventable patient injuries, progress has stagnated. The rate of preventable adverse events is not much different than it was when the problem was studied 35 years ago. Whatever the healthcare profession is doing to improve patient safety and eliminate mistakes is not working. It needs to change the way it operates.
As the old saying goes, “Sunlight is the best disinfectant.” Doctors and hospitals need to stop hiding their mistakes from the public and take ownership of and responsibility for the effects of these mistakes. Instead, the almost universal response of the medical profession is, “Deny, deny, deny.” It is long past time for a change.
