Each year, as many as 440,000 people in the U.S. die due to medical errors, despite the fact that medical professionals take many steps to keep their patients safe. There are many reasons that medical errors occur including the number of steps that are often required in treatments, the number of medical professionals involved in a patient’s care, and patients not understanding or being confused about their own care.
There are some common areas in which medical mistakes happen. The following patient safety challenges highlight those mistakes.
Wrong-side surgery can occur in a number of ways including the wrong part of a patient’s body being operated on, the wrong patient being operated on, or even the wrong type of surgery being performed. Wrong-site surgery is not a frequent occurrence. There were 111 cases in 2015 reported by The Joint Commission in its Top Standards Compliance Data for 2015. The Joint Commission works toward better patient safety by collecting and analyzing data from medically accredited organizations and certified programs.
While wrong-site surgery is not as prevalent as some other medical errors, it can be devastating and even fatal for the patients and families it affects.
Medication errors are much more common than wrong-site surgery. Mistakes with medication can happen in two main ways: a patient is given the wrong medication, or the patient is given the incorrect dose of the right medication. The U.S. Food and Drug Administration (USFDA) recently reported that medication errors result in a death a day and over 1.3 million injuries annually. While the use of computerized provider order entry (CPOE) systems has reduced the number of medication errors significantly in hospitals, there is still cause for concern. “Sound-alike” medications (drugs whose names are similar, but uses and effects are very different) are the cause of many of the more serious adverse drug events reported. The U.S. Department of Health and Human Services’ Patient Safety Network works with health care providers, hospitals, and pharmacists to reduce the number of medication errors.
Health Care-Acquired Infections
When a patient contracts an infection that is not related to the diagnosis or condition that he or she was admitted to the hospital for, it is called a health care-acquired infection, or HAI. Any infection that occurs within 48 hours of admittance is likely to be an HAI. The Centers for Disease Control and Prevention’s annual report, the National and State Healthcare-Associated Infections Progress Report (HAI Progress Report), does show that HAI occurrences declined for the most recent year reported (2014), but they are still a significant risk with about 1 in 25 hospital patients affected on any given day.
There are generally three risk factors that play a role in patients who acquire an HAI:
- Patient – Risk factors include the severity of the patient’s condition, how long the patient has been hospitalized, and the effectiveness of the patient’s immune system.
- Organizational – Risk factors include the overall cleanliness of the medical facility. Air filtration, cleanliness of the water systems and building surfaces, and the sterility of the medical devices and equipment are all included in organizational risk factors.
- Iatrogenic – Risk factors include the care with which the medical staff perform. Washing hands, antibiotic use, and the care used in invasive procedures like intravenous medication administration, catheterization, and intubation are all iatrogenic risk factors.
The 2016 report, Preventing Patient, estimates that between 700,000 and one million patients fall in hospitals in the U.S. every year. As many as 35 percent of those patients sustain injuries from falling, and nearly 11,000 falls prove to be fatal. The report noted that the most common areas at risk for patient falls are:
- Fall risk assessment issues
- Handoff communication issues
- Toileting issues
- Call light issues
- Educational and organizational culture issues
- Medication issues
While the report shows that hospitals are putting procedures in place to help prevent patient falls, there are still issues with the implementation of those procedures. Patients can take an active role in preventing their own falls by talking about their risk with doctors or nurses and taking preventative measures themselves.
When a patient is discharged from a hospital stay only to return within 30 days, it is considered a readmission. There are many patient-safety issues that can lead to a readmission, including being discharged prematurely, being discharged to unhealthy settings, or not receiving the information necessary for effective recovery.
The Affordable Care Act (ACA), enacted in 2012, brought readmission rates to the forefront of hospital operations. The Hospital Readmissions Reduction Program (HRRP) is included in the ACA, and it penalizes hospitals for avoidable re-admissions of Medicare patients. Since the program went into effect, readmission rates have dropped, but not significantly. In a study performed by the New England Journal of Medicine in 2016, data showed that readmission rates of the 3,387 hospitals in the study dropped from 21.5 percent to 17.8 percent for conditions targeted by the program, and from 15.3 percent to 13.1 percent for non-targeted conditions.
Diagnostic errors, or misdiagnoses, are explained as wrong, missed, or unintentionally delayed diagnoses. The Institute of Medicine report in brief, Improving Diagnosis in Health Care (September 2015), concluded that “most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences.”
Sometimes a misdiagnosis happens when a doctor diagnoses a patient with one condition or illness, when it is actually a completely different condition. For example, a heart attack can be mistaken for indigestion, anxiety or panic attack, or a stroke can be mistaken for a migraine, especially when the patient is younger.
But, diagnosing a condition incorrectly isn’t the only way that a misdiagnosis occurs. In fact, most cases of misdiagnosis involve either a delayed diagnosis or mismanagement of diagnostic testing, as opposed to mistaking one illness for another. Some of the common reasons for delayed diagnosis and mismanagement of testing includes:
- Failure to complete standard tests for symptoms
- Evaluating lab results incorrectly
- Failure to refer patient to a specialist
- Failure to take the time with the patient to adequately address symptoms
- Failure to follow up with patients, their lab results, and with the referred specialists
- For wrong-site surgery and medication errors: https://www.ahrq.gov/patients-consumers/care-planning/errors/20tips/index.html
- For health care-acquired infections: https://hospitalinfection.org/protect/patients
- For patient fall prevention: https://www.allinahealth.org/customer-service/be-prepared/for-your-hospital-stay/10-tips-to-prevent-falls-while-you-are-in-the-hospital/
- For misdiagnosis prevention: http://www.webmd.com/cancer/features/get-right-diagnosis#1
- For readmission prevention: http://www.rwjf.org/en/library/research/2013/01/care-about-your-care-discharge-checklist—-care-transition-plan.html