Journal Looks at Medical Errors Report Fallout
The medical error movement is fraught with pitfalls, said Dartmouth Medical School physicians in the November/December 2000 Effective Clinical Practice. The issue was devoted to medical errors and the ramifications of the Institute of Medicine (IOM) report, "To Err is Human: Building a Safer Health System." It also featured a critique by DMS overseer and journalist Susan Denzter of how the media covered the story.
In an editorial, "Is This Issue a Mistake?" journal editor H. Gilbert Welch, MD, and Elliott S. Fisher, MD, both of the White River Junction VAMC, wrote, "We hope that papers in this issue help highlight both the opportunities and the complexities involved in reviewing medical errors." They said loose language, such as equating errors with adverse events, has muddied the debate. The medical error movement, triggered anew by the November 1999 IOM report, may be missing the mark by focusing on errors of execution without also attending to errors in decision making such as when to test and treat.
Two DMS physicians examined the validity of numbers used to calculate medical errors risk and called for more credible estimates in, "How Many Deaths Are Due to Medical Error? Getting the Number Right." The IOM report cited studies that substantiate that adverse events occur in 2.9 to 3.7% of hospital admissions. Harold Sox, MD, and Steven Woloshin, MD, questioned the 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.
In "Developing a Culture of Safety in the Veterans Health Administration (VHA)," William Weeks, MD, of DMS, and James Bagian, MD, of the National Center for Patient Safety, detailed initiatives that might guide other health care organizations.The VHA is establishing one mandatory and one voluntary system to report adverse events and plans to bar code medications and computerize medical records.
John Birkmeyer, MD, of DMS and Michael Young, MD, of Fletcher Allen Health Center,VT reported that staffing hospitals with physicians trained in critical care could save almost 54,000 lives annually. (See also Leapfrog).
Press coverage, examined in a public policy article, "Media Mistakes in Coverage of the Institute of Medicine's Errors Report," also offers lessons, said Dentzer, health correspondent for PBS's The News Hour with Jim Lehrer. "...Although the news coverage was widespread, little of it went deeply into the reports analysis of the sources of medical errors or some of the reports highly controversial recommendations," she wrote. 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.