1 in 5 elderly U.S. patients injured by medical care

By Steven Reinberg HealthDay Reporter

(HealthDay News) — Nearly one in five Medicare patients are victims of medical injuries that often aren’t related to their underlying disease or condition, according to new research.

The injuries included: being given the wrong medication, having an allergic reaction to a medication, or receiving any treatment that led to more complications of an existing medical problem.

“These injuries are caused by the medical care or management rather than any underlying disease,” said lead researcher Mary Carter, director of the Gerontology Program at Towson University in Maryland.

About two-thirds of these injuries occurred during outpatient care, rather than in the hospital, the study findings showed.

While there has been a great deal of effort in trying to understand medical injury in hospitals, not as much has been done in clinics, doctor’s offices, outpatient surgery centers, emergency rooms and nursing homes, noted Carter.

“To really improve our ability to prevent these types of adverse events, we have to focus at least as much on outpatient care as we do on inpatient care,” Carter said.

Findings from the study were published online May 27 in the journal Injury Prevention. It’s important to note that while the people in the study all had Medicare insurance, the study didn’t show that having Medicare insurance caused any of these injuries.

For the study, Carter and her colleagues collected data on more than 12,500 Medicare patients who made claims between 1998 and 2005. Their average age was 76.

The researchers found that 19 percent of those included in the study experienced at least one adverse medical event. That’s higher than previous research estimates that suggested the rate of adverse medical events was probably around 13.5 percent for hospitalized patients, according to background information in the study.

“The rate of these injuries is probably higher than has been estimated,” she said.

Sixty-two percent of these injuries took place during outpatient care, the investigators found.

Older people, men and those from lower-income backgrounds were most at risk of an adverse medical event, the study authors found. They also found that people who had chronic medical conditions or who were disabled in some way were more at risk of a medical injury.

Each additional month of age was associated with a 1 percent increase in the risk of a medical injury. In addition, the risk of experiencing an adverse medical event increased by 27 percent for each chronic condition a person had, the report revealed.

The death rate among those who had experienced a medical injury was nearly twice as high as among patients who hadn’t had one, Carter said.

The consequences of these injuries were lasting. “We are seeing increased health care costs over a year following the injury with the greater use of medical services,” said Carter.

Dr. David Katz is director of the Yale University Prevention Research Center and president of the American College of Lifestyle Medicine. He said: “We have long known that medical care, while pledged to avoid harm above all, actually imposes quite a bit of it. Medical injury is all too common, and adverse effects of treatment are common, even in the absence of error.”

But, he added, a process of continuous assessment and systems-level reform is needed to reduce medical errors to the minimum.

“There is also need to cultivate more health by living well,” he said. “Medical injuries occurred in the context of treatment, and were more common with more serious conditions. That older patients with several chronic diseases and on multiple medications are more prone to adverse medical events is less than shocking.”

Hospital medical errors now the third leading cause of death in the U.S

Hospital medical errors now the third leading cause of death in the U.S. New study highlights the fact that estimates in ‘To Err is Human’ report were low September 20, 2013 | By Ilene MacDonald

Medical errors leading to patient death are much higher than previously thought, and may be as high as 400,000 deaths a year, according to a new study in the Journal of Patient Safety. The latest numbers are dramatically higher than those in the Institute of Medicine’s 1999 report, To Err is Human: Building A Safer Health System, which estimated that up to 98,000 people a year die because of hospital mistakes. The data for that report is based on medical record reviews from 1984 and doesn’t take into account studies published since 2008. The new study reveals that each year preventable adverse events (PAEs) lead to the death of 210,000-400,000 patients who seek care at a hospital. Those figures would make medical errors the third leading cause of death behind heart disease and cancer, according to Centers for Disease Control and Prevention statistics. The latest findings are based on research conducted by John T. James, Ph.D., who oversees the advocacy group Patient Safety America, an organization he founded in honor of his 19-year-old son who died in 2002 as the result of what he describes as negligent hospital care. James analyzed four recent studies that used the “Global Trigger Tool” to flag specific evidence in medical errors, such as medication stop orders or abnormal laboratory results, which point to an adverse event that may have harmed a patient. A physician must concur on these adverse event findings before they classify the severity of patient harm. Based on the weighted average of the four studies, he concluded that at least 210,000 deaths are due to preventable harm in hospitals. But because of the limitations of the tool and incomplete medical records, he wrote that the number is likely twice that figure, more than 400,000 deaths each year. “There was much debate after the IOM report about the accuracy of its estimates,” James wrote in the study. “In a sense, it does not matter whether the deaths of 100,000, 200,000 or 400,000 Americans each year are associated with PAEs in hospitals. Any of the estimates demands assertive action on the part of providers, legislators and people who will one day become patients.” The problem, James said, is that action and progress on patient safety has been slow. He wrote that he hoped these latest evidence-based estimates of 400,000 patient deaths each year will foster an “outcry for overdue changes and increased vigilance in medical care to address the problem of harm to patients who come to a hospital seeking only to be healed.” Lucian Leape, M.D., who served on the committee that wrote the “To Err Is Human Report,” told ProPublica that he believes James’ estimate is accurate. He said the committee knew at the time of its 1999 study that the numbers were low. “It was based on a rather crude method compared to what we do now,” Leape told ProPublica. Furthermore, he said, medicine is more complex now, which leads to more mistakes.

Hospital medical errors now the third leading cause of death in the U.S. – FierceHealthcare http://www.fiercehealthcare.com/story/hospital-medical-errors-third-leading-cause-death-dispute-to-err-is-human-report/2013-09-20#ixzz2rzUk7QAM. For more information:
- read the study
- here’s the ProPulica article
- see the 1999 IOM report
- here’s the CDC statistics
- check out the Patient Safety America website

Misdiagnosis is more common than drug errors or wrong-site surgery

Until it happened to him, Itzhak Brook, a pediatric infectious disease specialist at Georgetown University School of Medicine, didn’t think much about the problem of misdiagnosis.

That was before doctors at a Maryland hospital repeatedly told Brook his throat pain was the result of acid reflux, not cancer. The correct diagnosis was made by an astute resident who found the tumor — the size of a peach pit — using a simple procedure that the experienced head and neck surgeons who regularly examined Brook never tried. Because the cancer had grown undetected for seven months, Brook was forced to undergo surgery to remove his voice box, a procedure that has left him speaking in a whisper. He believes that might not have been necessary had the cancer been found earlier.

“I consider myself lucky to be alive,” said Brook, now 72, of the 2006 ordeal, which he described at a recent international conference on diagnostic mistakes held in Baltimore. A physician for 40 years, Brook said he was “really shocked” by his misdiagnosis.

But patient safety experts say Brook’s experience is far from rare. Diagnoses that are missed, incorrect or delayed are believed to affect 10 to 20 percent of cases, far exceeding drug errors and surgery on the wrong patient or body part, both of which have received considerably more attention.

Recent studies underscore the extent and potential impact of such errors. A 2009 report funded by the federal Agency for Healthcare Research and Quality found that 28 percent of 583 diagnostic mistakes reported anonymously by doctors were life-threatening or had resulted in death or permanent disability. A meta-analysis published last year in the journal BMJ Quality & Safety found that fatal diagnostic errors in U.S. intensive care units appear to equal the 40,500 deaths that result each year from breast cancer. And a new study of 190 errors at a VA hospital system in Texas found that many errors involved common diseases such as pneumonia and urinary tract infections; 87 percent had the potential for “considerable to severe harm” including “inevitable death.”

Misdiagnosis “happens all the time,” said David Newman-Toker, who studies diagnostic errors and helped organize the recent international conference. “This is an enormous problem, the hidden part of the iceberg of medical errors that dwarfs” other kinds of mistakes, said Newman-Toker, an associate professor of neurology and otolaryngology at the Johns Hopkins School of Medicine. Studies repeatedly have found that diagnostic errors, which are more common in primary-care settings, typically result from flawed ways of thinking, sometimes coupled with negligence, and not because a disease is rare or exotic.

The problem is not new: In 1991, the Harvard Medical Practice Study found that misdiagnosis accounted for 14 percent of adverse events and that 75 percent of these errors involved negligence, such as a failure by doctors to follow up on test results.

Despite their prevalence and impact, such mistakes have been largely ignored, Newman-Toker and others say. They were mentioned only twice in the Institute of Medicine’s landmark 1999 report on medical errors, an omission some patient safety experts attribute to difficulties measuring such mistakes, the lack of obvious solutions and generalized resistance to addressing the problem.
By Sandra G. Boodman

Nurses Remain Nation’s Most Trusted Professionals

Medscape Medical News
Jenni Laidman
Dec 06, 2012

Medical professionals are among the most trusted people in the United States, a new Gallup survey shows, with 85% of survey respondents ranking nurses highest for honesty and ethics, followed by pharmacists (75%) and physicians (70%).

The 2012 sampling was conducted via telephone November 26 through 29 among 1015 people aged 18 years and older in all 50 states and the District of Columbia. The survey results, published December 4, have a margin of error of ±4 percentage points and a confidence interval of 95%.

The poll asked respondents, “Please tell me how you would rate the honesty and ethical standards of people in these different fields — very high, high, average, low, or very low?” A list of 22 professions was then provided in random order to each person contacted. Spanish-speaking respondents were interviewed in Spanish.

Nurses, who have led the rankings for 11 consecutive years, were ranked “high” or “very high” for honesty and ethics among 85% of respondents. The survey has been conducted annually since 1976, and nurses were first included in 1999.

“This poll consistently shows that people connect with nurses and trust them to do the right thing,” said American Nurses Association President Karen A. Daley, PhD, MPH, RN, in an association news release. The only time nurses were not first on the list was 2001, after the terrorist attack of September 11, when firefighters ranked first. Firefighters have not been included in polling in any other years.

Engineers tied with physicians for third place, ranking 70%, followed by dentists at 62%, police officers at 58%, college teachers at 53%, and clergy at 52%. Psychiatrists ranked eighth, at 41%, and chiropractors ninth, at 38%, followed by bankers (28%) and journalists (24%).

At the very bottom were car salespeople, with 8% ranked high or very high, and members of Congress, at 10%.


Malpractice Threats in Well-Intended Patient Handoffs


Life-changing errors in the patient handoff from one doctor to another are becoming more frequent, and they are increasingly occurring among doctors with good intentions who think they’re providing fine care.

Some insurers say they’ve noticed a disturbing spike in the number of lawsuits stemming from avoidable failures when patients are transferred or handed off. The exact increase is difficult to quantify because malpractice cases take years to work through the legal system.

“It’s rare for there to be only one physician who follows a patient through the entire course of treatment,” said Alan Lembitz, MD, vice president of COPIC, a professional liability carrier based in Denver, Colorado. “Almost all claims have multiple defendants and points of contact.”

The potential for mishaps rises dramatically because of the increasing fragmentation in medicine. “The patient’s primary doctor may admit him, or maybe it’s the emergency department physician,” said Dr. Lembitz. “Then he may be seen by 3 or 4 hospitalists and a couple of specialists. Who will handle needed follow-up often isn’t clear.” When shifts change in hospitals, when one doctor refers the patient to another, and when patients are discharged, vital information often falls between the cracks.

An estimated 80% of serious medical errors involve miscommunication between caregivers when patients are handed off, resulting in severe patient injury or death, delays in treatment, and increased length of stay at the hospital, the Joint Commission’s Center for Transforming Healthcare said earlier this year when it released a new program [1] to help fix the broken communication process.

The Problem Is Extensive

Direct communication between hospitalists and primary care physicians is rare, happening only 3%-20% of the time, according to a 2007 study published in JAMA. [2] A majority of hospitalized patients are unable to name their doctor, [3] and a majority of discharge summaries don’t highlight tests and studies that are pending. [4]

“There are 4000 handoffs a day in a typical teaching hospital,” Joint Commission President Dr. Mark Chassin said. “If 90% go flawlessly, that’s still 400 failures per day.”

There’s a huge disconnect in how “sending” and “receiving” doctors perceive what each is doing — or should be doing.

For example, a 2011 study in Archives of Internal Medicine found that 69% of primary care physicians reported sending patients’ histories to specialists all or most of the time. Yet, only 35% of specialists said they routinely receive the information. Whereas 81% of specialists reported sending their results to the referring physician all or most of the time, only 62% of primary care physicians report receiving the information. [5]

Hospitalists expect that primary care physicians should relay all the previous laboratory and radiographic data that were available. A phone call would be even better, said Dr. Lembitz. “And the primary care doctor is thinking, ‘It would be nice if the hospitalist called me back after seeing my patient so that we could actually discuss this case.'”

The classic fumble in the patient handoff is when the specialist thinks the primary care doctor is going to take care of some aspect of follow-up, and the primary care doctor thinks the specialist is handling it.

Malpractice insurers that we interviewed gave these examples of handoff errors:

A 38-year-old woman detected a lump in her breast and was referred by her primary care physician to a surgeon. The surgeon found no mass, but recommended that she be reexamined in 1 month. Each physician assumed that the other would follow-up, Dr. Lembitz said. Nine months later, the patient returned to her doctor with a larger mass and was diagnosed with breast cancer.

A healthy newborn boy was treated by a neonatologist within the first 12 hours of his life. Although a bilirubin test was ordered, the covering neonatologist discharged the child within 24 hours, unaware of the laboratory results. At 60 hours, the baby was seen by a pediatrician at an ambulatory care center; a bilirubin test was again ordered before that doctor left for vacation, expecting that the laboratory would contact the parents and her call coverage physician.

The covering pediatrician (from a different group practice) didn’t have accurate contact information for the mother. The next day, when the regular pediatrician saw the fax from the laboratory, he contacted the mother and asked that the baby get to the hospital as soon as possible.

The patient was admitted at 77 hours but died of kernicterus, a preventable disease if had it been recognized on the basis of the 2 previous laboratory results. The bilirubin level was 16 mg/dL at 12 hours of age, 32 mg/dL at 60 hours of age, and 44 mg/dL on admission at 77 hours.

A test result requiring immediate action was called to a night doctor, “who not only did nothing, but also failed to tell the day doctor about it,” said Stella Fitzgibbons, MD, a hospitalist in Houston, Texas, who reviews malpractice cases. “That day doctor, for his part, was ‘just filling in’ and left the problem for the ‘regular doctor’ to deal with, causing expensive and irreversible problems for the patient.”

A 61-year-old woman was hospitalized with abdominal pain. A lesion was found in her spleen. Resection revealed an abscess with methicillin-resistant Staphylococcus aureus. An infectious disease specialist recommended a 4-week course of vancomycin.

One week later, the patient was transferred to a rehabilitation facility. An echocardiogram had shown subacute endocarditis, but the report on it was not returned until after discharge and was neither seen by nor relayed to the subsequent providers.

The patient’s nonhospital physician assistant had no records on this finding and was not sure why she was still receiving vancomycin. He stopped the medication 1 week later, especially because maintaining intravenous access was difficult for this patient. Two more weeks after the medication was stopped, the patient presented with a spinal abscess and paralysis — the result of a failure to transmit critical information.

“We’re seeing the same patterns of claims over and over again,” said Dr. Lembitz. “The inconsistent or incomplete handoff is what leads to the problem.”

Malpractice Threats in Well-Intended Patient Handoffs.  Medscape. Oct 04, 2012.