Medical Injuries Led to 32,600 Deaths, Cost $9.3 Billion in 2000, Study Finds
Medical injuries in U.S. hospitals in 2000 led to about 32,600 deaths, at least 2.4 million extra days of patient hospitalization and additional costs of up to $9.3 billion, according to a study published Tuesday in the Journal of the American Medical Association, the Wall Street Journal reports (Burton, Wall Street Journal, 10/8). Study authors Dr. Chunliu Zhan of the Agency for Healthcare Research and Quality and Dr. Marlene Miller of the Johns Hopkins Children's Center and colleagues analyzed records from 994 hospitals in 28 states, a sample representative of about 20% of U.S. hospitals (Fackelmann, USA Today, 10/8). Researchers considered 18 diagnostic billing codes previously found to be indicative of medical injuries, the Baltimore Sun reports. Those included accidental punctures, medical objects accidentally left in patients during surgery and sepsis infections (Bell, Baltimore Sun, 10/8). Because the analysis was based on billing data, researchers did not track some errors, such as adverse drug reactions (Wall Street Journal, 10/8). The study found that sepsis infections -- the "most serious complication" -- occurred in 2,592 patients, resulting in a 22% higher risk of death, $57,727 in additional costs and 11 extra days of hospitalization per patient, the AP/Detroit Free Press reports. Surgical wounds represented the second-most serious medical injury, with a nearly 10% higher risk of death, $40,323 in additional costs and nine extra days of hospitalization per patient (Tanner, AP/Detroit Free Press, 10/8). The authors concluded that medical injuries in hospitals "pose a significant threat to patients and incur substantial costs to society" and "are a serious epidemic confronting our health care system." The current study's estimated number of annual patient deaths as a result of medical injuries is smaller than the 44,000 to 98,000 cited in a 1999 study on medical errors by the Institute of Medicine; the Journal reports that IOM study used actual medical charts and smaller samples of patients. Zhan said that his study's use of "medical injuries" is roughly equivalent in meaning to the IOM's use of "medical errors."
The Journal reports that the study "breaks new ground and may carry more weight" because it included a database of 7.45 million hospital discharges, "far larger ... than is customarily used in medical outcomes studies." In addition, the study highlights "both the scope of the problem and the relative lack of action in solving it," according to the Journal (Wall Street Journal, 10/8). AHRQ Director Dr. Carolyn Clancy said, "This study gives us the first direct evidence that medical injuries pose a real threat to the American public and increase the costs of health care" (AHRQ release, 10/7). Miller said the research also "helps hospitals see what kind of return on investment they'll get" from implementing measures to reduce medical injuries (Baltimore Sun, 10/8). Zhan said that although the report does not address what progress has been made in reducing medical injuries since the 1999 IOM report, AHRQ has developed a fact sheet for patients to seek "safer treatment" as a measure to reduce injuries and complications, the AP/News reports (AP/Detroit News, 10/8).
In an accompanying editorial, Drs. Saul Weingart, assistant professor of medicine at Harvard Medical School, and Lisa Iezzoni, professor of medicine at the school, write that the study results are "clearly sobering." The editorial states that "patient safety measurement tools should ... focus on preventable injuries," but it adds, "Unfortunately, preventable injuries are technically difficult and expensive to capture." The editorial concludes, "Developing and validating a robust set of measurement tools is essential to move patient safety information out of the shadows and into the light" (Weingart/Iezzoni, JAMA, 10/7).
An abstract of the study is available online.