Epidemic of Hospital Harm

The Unhealthy His­to­ry of Avoid­able Hos­pi­tal Harm

Hos­pi­tal harm is the third lead­ing cause of death in the Unit­ed States and Cana­da, tak­ing the lives of hun­dreds of thou­sands of patients every year. Many times that num­ber are injured and often left severe­ly dis­abled.  The prin­ci­pal caus­es of these deaths and injuries are med­ica­tion errors, hospital-acquired infec­tions, falls, blood clots and pres­sure ulcers (bed sores), almost all of which are avoid­able. In any year, hos­pi­tal harm in the U.S. and Cana­da takes more lives than strokes, Alzheimer’s, kid­ney dis­ease, breast can­cer, pas­sen­ger train, air­line and auto­mo­bile acci­dents togeth­er.

Gov­ern­ment lead­ers, health­care pro­fes­sion­als and pol­i­cy mak­ers have known about the risks of hos­pi­tal care caus­ing pre­ventable injuries and deaths for well over a decade.  In 1999, the U.S. Insti­tute of Med­i­cine (IOM) released a ground-breaking report that warned:

Health care in the Unit­ed States is not as safe as it should be–and can be. At least 44,000 peo­ple, and per­haps as many as 98,000 peo­ple, die in hos­pi­tals each year as a result of med­ical errors that could have been pre­vent­ed, accord­ing to esti­mates from two major stud­ies. Even using the low­er esti­mate, pre­ventable med­ical errors in hos­pi­tals exceed attrib­ut­able deaths to such feared threats as motor-vehicle wrecks, breast can­cer, and AIDS.

Hos­pi­tal Harm Has Increased Over the Years

Rec­og­niz­ing that “the know-how already exists to pre­vent many of these mis­takes,” the report set a min­i­mum goal of reduc­ing hos­pi­tal errors by 50 per­cent over the next five years.  Not only was that tar­get not met, but the num­ber of med­ical mis­takes sub­stan­tial­ly increased. By 2010, the Office of Inspec­tor Gen­er­al for the Depart­ment of Health and Human Ser­vices said that bad hos­pi­tal care con­tributed to the deaths of 180,000 patients in Medicare alone in any giv­en year.  More research led to the dis­cov­ery of even high­er num­bers.  

As dif­fi­cult as these num­bers are to com­pre­hend, when hos­pi­tals are sub­ject­ed to a more rig­or­ous review of deaths and adverse out­comes, like the kind using the “Glob­al Trig­ger Tool” (instead of hos­pi­tal self-reporting), the num­bers in every case become stratos­pher­ic, sug­gest­ing that adverse events in hos­pi­tals may be ten times greater than pre­vi­ous­ly mea­sured.In 2013, the num­ber of avoid­able deaths from hos­pi­tal harm in the Unit­ed States had been esti­mat­ed to be up to 440,000, accord­ing to the work of John T. James. His method­ol­o­gy and con­clu­sion were endorsed by Dr. Lucian L. Leape, renowned as the father of the patient safe­ty move­ment world­wide.  In 2014, a com­mit­tee of the Unit­ed States Sen­ate adopt­ed the fig­ure set by Dr. James. 

Cana­di­an patient safe­ty researchers have esti­mat­ed between 56,000 and 63,000 patients are killed each year from med­ical errors, includ­ing hospital-acquired infec­tions.  A more recent Cana­di­an study, which did not include the province of Que­bec, report­ed that 1 in 18 hos­pi­tal­ized patients expe­ri­enced avoid­able med­ical errors in 2014 – 2015. In the U.S., it is esti­mat­ed that 15 mil­lion inci­dents of hos­pi­tal harm occur every year.

Pre­cise fig­ures on hos­pi­tal deaths and med­ical errors are dif­fi­cult to obtain, giv­en the vol­un­tary nature of hos­pi­tal report­ing and the fact that, in many cas­es, hos­pi­tals sim­ply don’t report when things go wrong.  As Daniel R. Levin­son, Inspec­tor Gen­er­al of the U.S. Depart­ment of Health and Human Ser­vices, not­ed in a report of hos­pi­tal care of Medicare patients: 

Hos­pi­tal staff did not report 86 per­cent of events to inci­dent report­ing systems…Further, hos­pi­tal staff report­ed only 2 of the 18 most seri­ous events in our sam­ple (i.e., those events that result­ed in per­ma­nent dis­abil­i­ty or death). Seri­ous events not cap­tured by inci­dent report­ing sys­tems includ­ed hospital-acquired infec­tions, such as a case of sep­tic shock lead­ing to death; and medication-related events, such as four cas­es of exces­sive bleed­ing because of the admin­is­tra­tion of blood-thinning med­ica­tion that also led to death. Inci­dent report­ing sys­tems did not cap­ture any of the five NQF Seri­ous Reportable Events and only one of the eight Medicare HAC events in our sam­ple. Despite the exis­tence of inci­dent report­ing sys­tems, hos­pi­tal staff did not report most events that harmed Medicare ben­e­fi­cia­ries. Indeed, some of the most seri­ous prob­lems, includ­ing some that caused patients to die, were not report­ed. (Empha­sis added.)

Noth­ing Like the Impact of Hos­pi­tal Harm is Tol­er­at­ed Any­where Else in Soci­ety 

This is an epi­dem­ic, any way you slice it. Would we tol­er­ate this lev­el of deaths and injuries asso­ci­at­ed with air­line or rail­way acci­dents?  If food poi­son­ing were caus­ing a frac­tion of the num­ber of deaths that occur from hos­pi­tal harm, would we remain pas­sive?  Would we allow our pub­lic lead­ers to remain indif­fer­ent?  Yet the deaths that occur in hos­pi­tals from med­ical errors is the equiv­a­lent of sev­er­al ful­ly loaded jum­bo jets falling out of the sky every day, killing every­one on board.  That’s not an accept­able safe­ty stan­dard for any indus­try, let alone one cre­at­ed to deliv­er heal­ing and care.

In the Unit­ed States, more than 4,000 errors occur in the oper­at­ing room every year. These include surgery on the wrong limb, on the wrong site of the body, and on the wrong patient, as well as “for­eign bod­ies,” like tow­els, sponges and sur­gi­cal instru­ments, left inside the patient dur­ing an oper­a­tion.  Canada’s record for leav­ing for­eign bod­ies inside patients is the worst of all G7 nations, accord­ing to the Orga­ni­za­tion for Eco­nom­ic Coop­er­a­tion and Devel­op­ment.  Cana­da has also set the record for lac­er­a­tions and punc­tures dur­ing hos­pi­tal surgery.

Infec­tions pose anoth­er seri­ous risk to hos­pi­tal­ized patients. They come in a vari­ety of forms and have a num­ber of dif­fer­ent sources and caus­es.  Their com­mon con­nec­tion is that they are all acquired inside the hos­pi­tal.  They all place patients at risk.  And they all add to the costs of health­care.  Usu­al­ly, they are avoid­able.  Hospital-acquired infec­tions have been a prob­lem for some time.  But the shock­ing facts are that some one mil­lion patients in U.S. and Cana­di­an hos­pi­tals  acquire these infec­tions each year, and up to 100,000 die as a result.

Canada’s Poor Record for Con­trol­ling Hos­pi­tal Infec­tions

In Cana­da, one-in-nine patients will acquire an infec­tion as a con­se­quence of their hos­pi­tal stay.  On that basis, it is Canada’s fourth lead­ing cause of death.  Canada’s infec­tion con­trol rate is one of the worst in the indus­tri­al­ized world, accord­ing to the World Health Orga­ni­za­tion.

The poor rate of hand hygiene com­pli­ance among health­care providers in the hos­pi­tal set­ting is a major rea­son for infec­tions being able to quick­ly spin out of con­trol.  Most hos­pi­tals are far from 100 per­cent com­pli­ance in hand hygiene before and after patient con­tact.  The fig­ures pro­vid­ed are based on hos­pi­tal self report­ing that is not ver­i­fied or exter­nal­ly mon­i­tored.

Aware­ness, Trans­paren­cy, Account­abil­i­ty Keys to Com­bat­ing Hos­pi­tal Harm

For­tu­nate­ly, there are excep­tions to the sit­u­a­tion described above.  Many hos­pi­tals do superb work, are dri­ven by a cul­ture of patient safe­ty and gift­ed with men and women who are a cred­it to their pro­fes­sions.  These hos­pi­tals are work­ing hard to com­bat this epi­dem­ic because they know that harm on the present scale is nei­ther inevitable nor tol­er­a­ble.  It can — and must — be beat­en.

But as long as hos­pi­tals can get away with under­re­port­ing errors or not report­ing adverse events — as long as they cling to a “deny and defend” strat­e­gy instead of build­ing a cul­ture of respect, trans­paren­cy, fair­ness and com­pas­sion — patients in the Unit­ed States, Cana­da and else­where will remain at risk.  And their fam­i­lies will con­tin­ue to be plagued by the life-altering night­mare that hos­pi­tal harm, and its after­math, can inflict.

The Cen­ter for Patient  Pro­tec­tion believes that rais­ing pub­lic aware­ness about the risks of hos­pi­tal harm, while strength­en­ing trans­paren­cy and account­abil­i­ty on the part of hos­pi­tals in their han­dling of med­ical errors, is vital to mak­ing patients safer. We hope the infor­ma­tion on these pages, gath­ered from dis­cus­sions with hun­dreds of patients and fam­i­lies and a review of thou­sands of pages of patient safe­ty lit­er­a­ture, will moti­vate you to explore the issues fur­ther. If you are a hos­pi­tal­ized patient or fam­i­ly mem­ber, we hope you will be encour­aged to become informed, engaged and pro­tect­ed as you nav­i­gate your health­care jour­ney.

 Infor­ma­tive Videos

U.S. Sen­ate Hear­ings into Hos­pi­tal Harm

PBS Seg­ment on New Fig­ures on Hos­pi­tal Harm

 

Con­sumers Union on Hos­pi­tal Care and Respect

 

ABC News on Surgery Errors

Hospital-Acquired Infec­tions

HAI from the CDC

HAI in Cana­da

A Still-Grieving Moth­er Talks abouCom­pas­sion and Trans­paren­cy (TED Talk)