So, how large is the problem of human error in medicine? Is it just the case of the occasional bad egg practitioner who is readily sent off to the regulators – to be hastily struck off the medical register for their supposedly egregious acts? Or is it just the rare case of the negligent physician whose supposed carelessness everybody self-righteously condemns? Or perhaps it is the case of the sporadic disruptive doctor who just doesn’t relate well enough with others? Or perhaps it is the case of the once-in-a-generation psychopathic practitioner who deliberately sets out to maim and kill?
All the above would have been true…but that would have been before some insightful doctors decided to study the problem systematically. And what they uncovered shook the very foundations of medicine. With statistics, they revealed that far from the rare mistake or the occasional negligent act, the daily fatality rate in hospitals was equivalent to a jumbo jet crashing every day!
You would be forgiven to think this is an over-exaggeration, as some have argued. But this is not a fanciful over-dramatisation, but a reality that set in motion a series of events that culminated in the seminal report published by the Institute of Medicine aptly titled ‘To Err is Human‘. This is the piece of work that blew the whistle on the scale of hospital-based adverse events, calculated to be the 8th leading cause of death in America, far exceeding the mortality from road traffic accidents, breast cancer, or AIDS!
The seminal report itself is based on the now iconic Harvard Medical Practice Study which was published in 2004 by Brennan and colleagues, acknowledged pioneers of the patient safety movement. What they did was to randomly review more than 30,000 case records from more than 50 randomly selected New York hospitals. They scrutinised the records for evidence of injury and death, and their results made for painful reading: adverse events occurred in almost 45% of all hospitalisations, and more than 25% of these were the result of negligent or substandard care. They also reported that 70% of the adverse events resulted in long-lasting disability, and more than 13% resulted in death. Based on their data, they calculated that there were more than 98,000 adverse events occurring in hospitals every year.
If you think this is just a problem in America, than you should perish the thought because Vincent and colleagues investigated the rate of adverse events in British hospitals in 2001. They retrospectively reviewed more than 1,000 medical and nursing records in two acute hospitals in the Greater London area, and they discovered that more than 10% of hospitalised patients experienced an adverse event. In their estimation, “about half of these events were judged preventable with ordinary standards of care”, and “a third of adverse events led to moderate or greater disability or death“. For a more stark figure, a report by the Chief Medical Officer in the UK, titled An organisation with a memory, cited the annual estimated number of adverse events occurring in British hospitals at 850,000!
The story is similar wherever the issue is investigated, from Australia to Canada. If these are the statistics in what are arguably the best healthcare systems in the world, then one shudders to think what is happening in less regulated and poorly audited healthcare systems. The problem is huge, and it is well worth the time to study it, and to see what remedies are at hand. Let us then prepare to take a walk in the dark tunnels of human error.