Attention to medical errors escalated over five years ago with the release of a study from the Institute of Medicine (IOM), To Err is Human
, which found that between 44,000 and 98,000 Americans die each year in U.S. hospitals due to preventable medical errors. Hospital errors rank between the fifth and eighth leading cause of death, killing more Americans than breast cancer, traffic accidents or AIDS. Serious medication errors occur in the cases of five to 10 percent of patients admitted to hospitals. These numbers may understate the problem because they do not include preventable deaths due to medical treatments outside of hospitals.
Since the release of the IOM study, there has been greater focus on the quality of healthcare provided in the U.S. Quality experts agree that one of the most common cause of errors is the medical system itself, not the individuals functioning within the system. Publication of the IOM report triggered substantial public and private sector activity, including the formation of the National Patient Safety Foundation by the American Medical Association, the creation of a non-punitive sentinel events reporting system by the Joint Commission for the Accreditation of Healthcare Organizations, and the establishment of new public private partnerships by the Veterans Health Administration and others.
Still, experts agree that there is much more work to do. For example, fewer than 3% of hospitals have implemented computerized drug ordering systems which one study found to reduce medication errors by 86%. In a December 2002 Kaiser Family Foundation survey, only 5% of physicians identified medical errors as a top health care concern. Shortly after the release of the 1999 IOM report, Congress gave $50 million to the U.S. Agency for Healthcare Research and Quality for research into the causes and prevention of medical errors. Beyond that, a flurry of legislative proposals in the 106th and 107th Congress resulted in stalemate over issues such as whether error reporting should be mandatory or voluntary and confidential or publicly released. Meanwhile, controversy over how to best address medical errors has entered into other debates, incuding whether the federal government should restructure the current medical malpractice system. States have also been a part of this debate, as several now have mandatory error reporting rules and statutes with a patchwork of differing requirements.
As federal and state policymakers debate the issues related to reducing medical errors, discussion will likely focus on several key issues, including:
- What kind of standardized national reporting of medical errors should be established? Should it be voluntary or mandatory? Should it be confidential or publicly reported? In which cases?
- What agency should be designated to receive error reports? What authority should the agency have to act on reports?
- What kind of reporting may or should be required for “near miss” events? What protections should be provided to reporters of errors and near misses? What effect should this new reporting system have on existing state reporting systems?
- Should Congress set national standards for mandatory overtime by nurses and limitations on work hours for medical interns and residents, both of which have been tied to increased medical errors?
- Should Congress mandate hospitals to install computerized drug order entry systems and other technologies with proven ability to reduce errors? If so, should the federal government provide financial support to some or all hospitals to install these systems?
- Should the federal government set clear goals for the reduction of errors over a period of years, particularly for Medicare and Medicaid patients? Should penalties and/or incentives be created for providers to reduce errors?
- What steps can Congress and state legislatures take to alleviate a serious national shortage of nurses – because many medical errors have been linked with understaffing of nurses and use of temporary nurses?
- What is the role of regulatory agencies such as the Joint Commission on the Accreditation of Healthcare Organizations and the National Committee on Quality Assurance in national reform on medical errors?
- Should any reports submitted under a medical errors reporting system be admissible as evidence in medical malpractice cases?
Acknowledgements: This issue module was prepared by Allison Woo, Usha Ranji, and Alina Salganicoff of the Kaiser Family Foundation.
Updated: May 2008