Journal Looks at Fallout from Institute of Medicine Report on Medical Errors

HANOVER, NH -- The medical error movement is fraught with pitfalls, according to Dartmouth Medical School physicians who are among the authors of a special issue of Effective Clinical Practice devoted to medical errors and the ramifications of last year's Institute of Medicine (IOM) report, "To Err is Human: Building a Safer Health System." Public policy articles also include a journalist's critique of media coverage.

In an editorial, "Is This Issue a Mistake?" for the November/December Effective Clinical Practice, journal editor Dr. H. Gilbert Welch and Dr. Elliott S. Fisher, both of Dartmouth Medical School and the White River Junction VAMC, write, "We hope that papers in this issue help highlight both the opportunities and the complexities involved" in reviewing medical errors. The authors say loose language, such as equating errors with adverse events, has muddied the debate. Moreover, the medical error movement itself, triggered anew by the release of the November 1999 IOM report, may be missing the mark by restricting the focus on errors of execution without also attending to errors in decision making such as when to test and treat.

Two DMS physicians examine the validity of numbers used to calculate medical errors risks. The IOM report cited studies that substantiate that adverse events occur in 2.9 to 3.7 % of hospital admissions. Drs. Harold Sox and Steven Woloshin question the IOM claim that about half of these adverse events are preventable, and cast doubt on the estimate that up to 98,000 hospitalized Americans die each year because of preventable medical errors. To appropriately allocate limited resources to this problem, policy makers will need more credible estimates they say in, "How Many Deaths Are Due to Medical Error? Getting the Number Right."

The article "Developing a Culture of Safety in the Veterans Health Administration (VHA)" by Dr. William B. Weeks of DMS, and Dr. James P. Bagian of the National Center for Patient Safety, Michigan, details VHA safety initiatives that might guide other health care organizations. The VHA has adopted a systems approach toward assuring patient safety and is establishing one mandatory and one voluntary system to report adverse events. Other efforts include bar coding all medications and computerizing medical records. "Although progress has been made, patient safety efforts require constant attention," they stress.

DMS physicians Dr. John Birkmeyer, who helped launch the Leapfrog Group, a business consortium to leverage hospital safety, and Dr. Michael Young of Fletcher Allen Health Center, Vermont, report that staffing hospitals with physicians trained in critical care could save almost 54,000 lives annually. Leapfrog recently unveiled three recommendations to help improve quality of care in hospitals: critical care specialists in ICUs, prescription systems and high volume performance of specialized procedures.

Press coverage, examined in a public policy article, "Media Mistakes in Coverage of the Institute of Medicine's Errors Report," also offers lessons, says Susan Dentzer, health correspondent for PBS's The NewsHour with Jim Lehrer. "...Althouth the news coverage was widespread, little of it went deeply into the report's analysis of the sources of medical errors or some of the report's highly controversial recommendations," writes Dentzer, a Dartmouth College trustee. While media "misjudgments" may have misled the public, the saga illustrates the struggle reporters face as they seek to convey the nuances and complexity of findings in meaningful yet interesting stories.

Effective Clinical Practice is published by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM) and the Alliance of Community Health Plans. For further information, contact Lynda Teer, 215-351-2655 or 800-523-1546, ext. 2655.

Hali Wickner

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