PATIENT SAFETY: Medical Mistakes Cost Up to $29B
The nation's health care system has failed to take sufficient measures to ensure patient safety and should implement major industry reforms, according to a strongly critical report issued yesterday by the Institute of Medicine. Citing studies that suggest as many as 98,000 hospitalized patients die each year because of medical errors, the expert panel behind the report suggests a four-part plan to create regulatory and financial incentives for safer care, with a goal of reducing errors by at least 50% across the next five years (National Academies release, 11/29). The recommendations of the IOM, which is a branch of the National Academy of Sciences, have a good chance of being adopted, the New York Times reports, because they coincide with bipartisan efforts by Congress and the Clinton administration to strengthen patients' rights and improve health care quality (Pear, 11/30). The report makes the following recommendations:
- Mandatory reporting to states, first by hospitals and eventually by other providers, of medical errors. Only about a third of the states currently require reporting of errors, with specific requirements and penalties varying widely.
- The creation of a federal Center for Patient Safety within HHS, which would fund patient safety research, set national safety goals and track progress in meeting them, and help disseminate information on best practices in patient safety.
- More stringent practices by regulatory, licensing and consumer groups, including periodic re-examinations of physicians, nurses and other providers, more safety-conscious purchasing decisions by employers and other health insurance consumers, and greater efforts by the FDA to eliminate confusing drug and device packaging and names of drugs that sound alike.
- Fostering a culture in which safety is a main priority by developing systems designed to minimize errors instead of focusing blame on individuals.
Not Just Hospitals
Hospitals represent only part of the overall problem, the report stresses. Outpatient care centers, physicians' offices, nursing homes and retail pharmacies play important roles in patient care, but errors in those settings are more difficult to measure. Errors also create both tangible and intangible costs. The total national cost of preventable adverse events is estimated at between $17 billion and $29 billion, of which only $8.8 billion is spent to correct medical problems caused by mistakes. But other costs, impossible to measure directly, include patients' physical and psychological suffering, lost worker productivity and diminished morale and job satisfaction for health care workers.
Encouraging Systemic Change
Taken as a whole, the panel's recommendations seek to promote the kind of systemic approach to safety that has been used successfully in other industries, such as commercial aviation, but is currently lacking in health care. Proven safety principles, such as standardization of equipment and processes and designing jobs with safety in mind, should be adopted by all health care institutions and overseen by national regulators, the report says (National Academies release, 11/29).