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Medical errors are third-leading cause of death in U.S., new analysis finds

Creative Commons/Michael Coté
The study finds that based on a total of 35,416,020 hospitalizations, 251,454 deaths resulted from a medical error.

Medical errors are now the third-leading cause of death in the United States, claiming more than 250,000 deaths per year, according to a new study published Tuesday in the journal BMJ.

Only heart disease and cancer take more American lives, say the study’s authors. 

But even that stunning finding probably understates the true incidence of death due to medical error because U.S. death certificates do not provide a way of acknowledging such errors and because the estimate is based only on inpatient (hospital) deaths, say the study’s authors, Dr. Martin Makary, a professor of surgery, and Michael Daniel, a research fellow, at Johns Hopkins University in Baltimore, Md.

Even so, the new estimate of medical-error deaths is more than 100,000 higher than that presented in a much-publicized 1999 study by the Institute of Medicine (now the National Academies of Science, Engineering and Medicine) — a study that Makary and Daniel say was based on limited data and is now outdated.

How estimates were reached

Medical errors are defined in the new study as “an unintended act (either of omission or commission) or one that does not achieve its intended outcome, the failure of a planned action to be completed as intended (an error of execution), the use of a wrong plan to achieve an aim (an error of planning), or a deviation from the process of care that may or may not cause harm to the patient.”

As Makary and Daniel point out, many medical errors are nonconsequential, but some “can end the life of someone with a long life expectancy or accelerate an imminent death.” It was those lethal errors that the two researchers focused on.

For their study, Makary and Daniel examined four studies that examined medical death rate data from 2000 to 2008 — since the IOM study. Then, using hospital admission rates from 2013, they extrapolated that based on a total of 35,416,020 hospitalizations, 251,454 deaths resulted from a medical error.

That’s about 9.5 percent of all deaths each year in the U.S.

More Americans died of heart disease (611,105) and of cancer (584,881) in 2013, according to statistics from the Centers for Disease Control and Prevention (CDC).   

But if Makary and Daniel’s estimates are correct, medical errors shortened more lives than all other causes of death on the CDC list, including chronic respiratory disease (149,205), accidents (130,557), stroke and other cerebrovascular diseases (128,978), Alzheimer’s disease (84,767) and diabetes (56,979).

“Top-ranked causes of death as reported by the CDC inform our country’s research funding and public health priorities,” said Makary in a released statement. “Right now, cancer and heart disease get a ton of attention, but since medical errors don’t appear on the list, the problem doesn’t get the funding and attention it deserves.”

Strategies for improvement

This is not just a U.S. problem. “Medical error leading to patient death is under-recognized in many other countries, including the UK and Canada,” write Makary and Daniel.

Nor is it a problem that will ever go away completely. As the two researchers point out, “Human error is inevitable.”

Yet, as they also note, “although we cannot eliminate human error, we can better measure the problem to design safer systems mitigating its frequency, visibility, and consequences. 

Makary and Daniel suggest several strategies to reduce deaths from medical care.  Errors should be made more visible so that doctors, nurses and others are aware of their effects — and so that more safety nets can be put in place to prevent them, they say.  Furthermore, hospitals should undertake a rapid independent investigation into deaths to determine if human error was a possible contributor.

Such efforts are “an important prerequisite to creating a culture of learning from our mistakes, thereby advancing the science of safety and moving us closer towards creating learning health systems,” they stress. 

This transparency should be extended to death certificates, the researchers add. 

“Instead of simply requiring cause of death, death certificates could contain an extra field asking whether a preventable complication stemming from the patient’s medical care contributed to the death,” they write. “… When a medical error results in death, both the physiological cause of the death and the related problem with delivery of care should be captured.”

That data could then be shared with researchers to improve patient safety, both nationally and internationally — “in the same way as clinicians share research and innovation about coronary artery disease, melanoma, and influenza,” write Makary and Daniel.

“Sound scientific methods, beginning with an assessment of the problem, are critical to approaching any health threat to patients,” they conclude. “The problem of medical error should not be exempt from this scientific approach. More appropriate recognition of the role of medical error in patient death could heighten awareness and guide both collaborations and capital investments in research and prevention.”

FMI: You can read Makary and Daniel’s analysis on the BMJ website.       

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Comments (3)

  1. Submitted by Neal Rovick on 05/04/2016 - 11:37 am.

    Being a spouse of a participant in the receiving end of the medical world has pushed home how precarious one’s position is as a patient.

    I have observed a rapid misdiagnose (fortunately) of a rare, degenerative, gruesomely fatal disease because the doctor was pissed off about having a patient added to his schedule. His scribbled diagnosis, and statement “there’s nothing to be done” took six months of work and worry to actually find someone who was willing to look for this rare condition and verify if it was true or not.

    I have observed a joint replacement where there was supposed to be close attention to pain management and medication timing, and it was a struggle from immediately from the operation to release from the rehab place to get medication delivered within an hour or two of when it was supposed to be had. And because of pushing the medication back time after time, the patient then had to either stay up til midnight to get the medication, or be woken up a hour or two after going to sleep to get the next medication.

    I have observed the surgeon giving the exercises to be done after the joint replacement operation, the hospital pooh-poohing those instructions for their own version of exercises, a third set mandated by the rehab facility, and a completely different set said to be the cats-meow by the PT facility.

    I have observed scrupulous infection control mandated by the first surgeon who did the replacement, and abysmal infection control in an emergency operation by an abdominal surgeon 3 weeks later (who knew our concerns about the ramifications of infection in a replaced joint) that resulted in a serious infection subsequently. And then sent home with a re-opened incision to pack with a wick every day and we asked about the infection risk and sterile procedures to be followed during the wick packing and the second surgeon has the gall to say “I don’t want to feed into your fears about infection.”

    The second surgeon also prescribe an antibiotic that has serious joint and tendon side effects to a patient that had the joint operations where the joint and associated tendons are already stressed to the max.

    Another joint was recommended for surgery. Two doctor gave two different diagnosis as to the exact problem and therefore recommended entirely different procedures to be done. So a third opinion gave an entirely different diagnosis and the recommendation of a complete joint replacement. And what is entirely bizarre about it, the same MRI reader read the pictures in two entirely different ways–one with minimal surgery and the next with a complete joint replacement.

    So,as a result of this and several other incidents, in the short space of three years the belief in the strength and quality of a medical system was entirely destroyed. I can’t begin to count the number of times where one person in the system would say”I don’t know why they would say/do that” when we told the person what the other medical person said or did.

    It’s a broken system.

    And errors are a big part of the problem.

    • Submitted by Pat Terry on 05/04/2016 - 02:05 pm.

      Doctors

      I have a friend who is a family practice doctor. Once a month people come in and tell him that he is spending too much time per patient. That he needs to get them in and out faster in order to see more patients. The system – which he hates – is driven entirely by revenue.

  2. Submitted by L.A. Krahn on 05/04/2016 - 12:28 pm.

    Neal’s ordeals

    Probably the sickest thing about the article and Neal’s example in his comment — is every individual involved is getting paid for keeping the status quo.
    As long as claims are paid, who cares about quality, efficiency, teamwork or coordination? Change is coming: Medicare soon plans to redefine physician payment based on quality and outcome measures, as a test.

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