What is the third most frequent cause of death?

Hospital Errors are the Third Leading Cause of Death in U.S., and New Hospital Safety Scores Show Improvements Are Too Slow

Washington, D.C., October 23, 2013 – New research estimates up to 440,000 Americans are dying annually from preventable hospital errors. This puts medical errors as the third leading cause of death in the United States, underscoring the need for patients to protect themselves and their families from harm, and for hospitals to make patient safety a priority.

Released today, the Fall 2013 update to The Leapfrog Group (Leapfrog) Hospital Safety Score assigns A, B, C, D and F grades to more than 2,500 U.S. general hospitals. It shows many hospitals are making headway in addressing errors, accidents, injuries and infections that kill or hurt patients, but overall progress is slow. The Hospital Safety Score is calculated under the guidance of the Leapfrog Blue Ribbon Expert Panel, with a fully transparent methodology analyzed in the peer-reviewed Journal of Patient Safety.

Leapfrog, an independent, national nonprofit organization that administers the Score, is an advocate for patient safety nationwide.

“We are burying a population the size of Miami every year from medical errors that can be prevented. A number of hospitals have improved by one or even two grades, indicating hospitals are taking steps toward safer practices, but these efforts aren’t enough,” says Leah Binder, president and CEO of Leapfrog. “During this time of rapid health care transformation, it’s vital that we work together to arm patients with the information they need and tell doctors and hospitals that the time for change is now.”

As result of the push for more public reporting of hospitals’ safety efforts, Leapfrog added two new measures to the latest Hospital Safety Score release, including Catheter-Associated Urinary Tract Infections (CAUTIs) and Surgical Site Infections: Colon (SSI: Colon). While CAUTIs and SSI: Colon have not received as much public attention as other measures, they are among the most common hospital infections and claim a combined 18,000 lives each year. With data from the CMS Hospital Compare website as well as the Leapfrog Hospital Survey, Leapfrog now has the publicly available data needed to calculate these critical measures into the Score.

CAUTI and SSI: Colon are among the 28 measures of publicly available hospital safety data used to produce a single grade representing a hospital’s overall safety rating.

The Hospital Safety Score is a public service available at no cost online or on the free mobile app at www.hospitalsafetyscore.org. A full analysis of the data and methodology used is also available on the Hospital Safety Score website.

Key Findings

• On average, there was no improvement in hospitals’ reported performance on the measures included in the score, with the exception of hospital adoption of computerized physician order entry (CPOE). The expansion in adoption of this lifesaving technology suggests that federal policy efforts to improve hospital technology have shown some success.
• Of the 2,539 general hospitals issued a Hospital Safety Score, 813 earned an “A,” 661 earned a “B,” 893 earned a “C,” 150 earned a “D” and 22 earned an “F.”
• While overall hospitals report little improvement in safety, some individual hospitals (3.5 percent) showed dramatic improvements of two or more grade levels.
• The states with the smallest percentage of “A” hospitals include New Hampshire, Arkansas, Nebraska and New Mexico. No hospitals in New Mexico or the District of Columbia received an “A” grade.
• Maine claimed the number-one spot for the state with the highest percentage of “A” hospitals.
• Kaiser and Sentara were among the hospital systems that achieved straight “A” grades, meaning 100 percent of their hospitals received an “A.”

For more information about the Hospital Safety Score or to view the list of state rankings, please visit www.hospitalsafetyscore.org. Journalists interested in scheduling an interview should contact LeapfrogMedia@sternassociates.com.

About The Leapfrog Group

The Hospital Safety Score is an initiative of The Leapfrog Group (www.leapfroggroup.org), a national nonprofit organization using the collective leverage of large purchasers of health care to initiate breakthrough improvements in the safety, quality and affordability of health care for Americans. The flagship Leapfrog Hospital Survey allows purchasers to structure their contracts and purchasing to reward the highest performing hospitals. The Leapfrog Group was founded in November 2000 with support from the Business Roundtable and national funders and is now independently operated with support from its purchaser and other members.

The Leapfrog Hospital Safety Grade

The Leapfrog Hospital Safety Grade is a public service provided by The Leapfrog Group, an independent nonprofit organization committed to driving quality, safety, and transparency in the U.S. health system.

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            © Copyright 2023, The Leapfrog Group. Updated May 3, 2023.

            Are medical errors really the third most common cause of death?

            

            You can guarantee that during any discussion about human factors in Medicine the statistic that medical errors are the third most common cause of patient death will be thrown up. A figure of 250,000 to 400,000 deaths a year is often quoted in the media. It provokes passionate exhortations to action, of new initiatives to reduce error, for patients to speak up against negligent medical workers.

            It’s essential that everyone working in healthcare does their best to reduce error. This blog is not looking to argue that human factors aren’t important. However, that statistic seems rather large. Does evidence really show that medical errors kill nearly half a million people every year? The short answer is no. Here’s why.

            

            Where did the figure come from?

            The statistic came from a BMJ article in 2016. The authors Martin Makary and Michael Daniel from John Hopkins University in Baltimore, USA used previous studies to extrapolate an estimate of the number of deaths in the US every year due to medical error. This created the statistic of 250,000 to 400,000 deaths a year. They petitioned the CDC to allow physicians to list ‘medical error’ on death certificates. This figure, if correct, would make medical error the third most common cause of death in the US after heart disease (610,000 deaths a year) and cancer (609, 640 deaths a year.) If correct it would mean that medical error kills ten times the number of Americans that automobile accidents do. Every single year.

            Problems with the research

            Delving deeper Makary and Daniel didn’t look at the total number of deaths every year in the US, which is 2,813,503. Instead they looked at the number of patients dying in US hospitals every year, which has been reported at 715,000. So if Makary and Daniel are correct with the 250,000 to 400,000 figure that would mean that 35-58% of hospital deaths in the US every year are due to medical error. This seems implausible to put it mildly.

            It needs to be said that this was not an original piece of research. As I said earlier this was an analysis and extrapolation of previous studies all with flaws in their design. In doing their research Makary and Daniel used a very broad and vague definition of ‘medical error’:

            “Medical error has been defined as an unintended act (either of omission or commission) or one that does not achieve its intended outcome, the failure of a planned action to be completed as intended (an error of execution), the use of a wrong plan to achieve an aim (an error of planning), or a deviation from the process of care that may or may not cause harm to the patient.”

            It’s worth highlighting a few points here:

            Let’s look at the bit about “does not achieve its intended outcome”. Let’s say a surgery is planned to remove a cancerous bowel tumour. The surgeon may well plan to remove the whole tumour. Let’s say that during the surgery they realise the cancer is too advanced and abort the surgery for palliation. That’s not the intended outcome of the surgery. But is it medical error? If that patient then died of their cancer was their death due to that unintended outcome of surgery? Probably not. Makary and Daniel didn’t make that distinction though. They would have recorded that a medical error took place and the patient died.

            There was no distinction as to whether deaths were avoidable or not. They used data designed for insurance billing not for clinical research. They also didn’t look at whether errors “may or may not cause harm to the patient”. Just that they occurred. They also applied value judgements when reporting cases such as this:

            “A young woman recovered well after a successful transplant operation. However, she was readmitted for non-specific complaints that were evaluated with extensive tests, some of which were unnecessary, including a pericardiocentesis. She was discharged but came back to the hospital days later with intra-abdominal hemorrhage and cardiopulmonary arrest. An autopsy revealed that the needle inserted during the pericardiocentesis grazed the liver causing a pseudoaneurysm that resulted in subsequent rupture and death. The death certificate listed the cause of death as cardiovascular.”

            Notice the phrase “extensive tests, some of which were unnecessary”. Says who? We can’t tell how they made that judgement. It is unfortunate that this patient died. Less than 1% of patients having a pericardiocentesis will die due to injury due to the procedure. However, bleeding is a known complication of pericardiocentesis for which the patient would have been consented. Even the most skilled technician cannot avoid all complications. Therefore it is a stretch to put this death down to medical error.

            This great blog by oncologist David Gorksi goes into much more detail about the flaws of Makary and Daniel’s work.

            So what is the real figure?

            A study published earlier this year (which received much less fanfare it has to be said) explored the impact of error on patient mortality. They studied the impact of all adverse events (medical and otherwise) on mortality rates in the US between 1990 and 2016. They found that the number of deaths in that whole 26 year period due to adverse events was 123,603. That’s 4754 deaths a year. Roughly one hundredth the figure banded around following Makary and Daniel (2016). Based on 2,813,503 total deaths in the US every year that makes adverse events responsible for 0.17% of deaths in the US. Not a third. 0.17%.

            Of course, 4754 deaths every year due to adverse events is 4754 too many. One death due to adverse events would be one too many. We have to study and change processes to prevent these avoidable deaths. But we don’t do those patients any favours by propagating false figures.

            Estimates of preventable hospital deaths are too high, new study shows

            A meta-analysis of eight studies has found that previous estimates of preventable hospital deaths in the United States may be as much as four times too high.

            By Bill Hathaway
            January 28, 2020

            

            Previous estimates of preventable deaths of hospitalized patients may be two to four times too high, a new Yale School of Medicine study suggests.

            The meta-analysis of eight studies of inpatient deaths, published in the Journal of General Internal Medicine, puts the number of preventable deaths at just over 22,000 a year in the United States, instead of the oft-cited 44,000-98,000 estimate of a landmark 1999 study by the Institute of Medicine. Other frequently cited studies have placed the number of deaths as high as 250,000 deaths per year, which would make medical error the third leading cause of death, behind cancer and cardiovascular disease.

            We still have work to do, but statements like ‘the number of people who die unnecessarily in hospitals is equal to a jumbo jet crash every day’ are clearly exaggerated.

            “ We still have work to do, but statements like ‘the number of people who die unnecessarily in hospitals is equal to a jumbo jet crash every day’ are clearly exaggerated,” said corresponding author Benjamin Rodwin, assistant professor of internal medicine at Yale.

            The reason for the wide disparity in estimates of preventable hospital deaths is relatively simple, Rodwin said. Studies like the 1999 Institute of Medicine project began by looking at admitted patients with any adverse event, such as an incorrect diagnosis or delay in therapy, then at how many of those errors were preventable and caused harm, and ultimately at how many of those errors led to the death of a patient. This method could have introduced more opportunities for bias and error, the Yale researchers said.

            Instead, in their meta-analysis they included only studies conducted after 2007 that took a different and, they argue, more direct approach. Each of the component studies started with hospital deaths and worked backward to determine their cause and whether they were preventable — for instance, resulting from a wrong diagnosis or a failure to manage a condition properly.

            The new study also shows that the number of previously healthy people who die every year from hospital error is about 7,150. The remainder of preventable deaths occurred in patients with less than a three-month life expectancy.

            Most of the hospital errors involved poor monitoring or management of medical conditions, diagnostic errors, and errors related to surgery and procedures, the study shows.

            Rodwin noted it is possible that the higher estimates of patient deaths in hospitals publicized two decades ago may actually have led to increased oversight in hospitals and itself reduced the number of errors and preventable deaths found in the studies included in the meta-analysis.

            He also stressed that studies included in the meta-analysis were conducted in hospitals in Canada and Europe, and estimates for the United States were extrapolated from those findings.

            “ We still need more studies in the United States that utilize a more direct approach to estimating preventable hospital deaths,” he said.

            Craig Gunderson, associate professor of medicine, is senior author of the paper.

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