Quehaceres de Medicos

In 1999, the Institute of Medicine (IOM) issued a report, To Err Is Human: Building a Safer Health System. According to this report, 44,000 to 98,000 people die in hospitals each year as the result of medical errors that could be prevented. These figures would make medical errors the eighth leading cause of death in the U.S., ahead of deaths from motor vehicle accidents, breast cancer or AIDS. Medication errors alone may be responsible for about 7,000 deaths per year.
The IOM defines patient safety as freedom from accidental injury and medical error. Medical error is "the failure to complete a planned action as intended or the use of a wrong plan to achieve an aim."
Errors occur in hospitals as well as in other health care settings, such as physicians' offices, nursing homes, pharmacies, urgent care centers, and homes. Unfortunately, very little data exist on the extent of the problem outside of hospitals. The IOM report indicated, however, that many errors probably occur outside the hospital.
Medical errors are costly. The IOM report estimates that medical errors cost the nation about $37.6 billion each year. About $17 billion of those costs are associated with preventable errors. About half of the expenditures for preventable medical errors are for direct health care cost.
Awareness of the problems of medical errors and patient safety has been growing. Americans have a very real fear of medical errors. According to a national poll conducted by the National Patient Safety Foundation:

• Four out of 10 people who responded (42 percent) had been affected by a medical error, either personally or through a friend or relative.
• Nearly one third of people who responded (32 percent) indicated that the error had a permanent negative effect on the patient's health.

Overall, the people who responded thought the health care system was "moderately safe." But another survey, conducted by the American Society of Health-System Pharmacists, found that Americans are "very concerned" about:

• Being given the wrong medicine (61 percent).
• Being given two or more medicines that interact in a negative way (58 percent).
• Complications from a medical procedure (56 percent).

Where's the problem? Most people believe that medical errors are the fault of a healthcare provider. When asked about possible solutions to medical errors:

• Three out of four people who responded thought it would be most effective to "keep health professionals with bad track records from providing care."
• Nearly 70 percent thought the problem could be solved through "better training of health professionals."

But the IOM report said that most medical errors are not due to a person. Instead, they are related to the way things happen. The key to reducing medical errors is to improve the way care is delivered and not to blame a person. Health care professionals are human. Like everyone else, they make mistakes. Improving the system can reduce error rates and improve the quality of health care:

• A 1999 study showed that if a pharmacist went along with doctors on medical rounds, errors related to medication ordering could drop by as much as 66 percent.
• Using standard guidelines, establishing protocols, and standardizing equipment has reduced errors related to anesthesia by nearly sevenfold.
• One veteran's hospital uses hand-held computers and bar codes for ordering medicines. The hospital's medication error rate dropped by 70 percent. Soon, all VA hospitals will use this system.

Most people believe that medical errors usually involve drugs or surgeries where something goes wrong. A patient may get the wrong prescription or dosage, or a sponge used to soak up blood during a surgery may be left in the patient. However, there are many other types of medical errors, including:

• Diagnostic errors. The wrong diagnosis may mean that the patient doesn't get the right kind of therapy or treatment. Test results could be misinterpreted. The patient may fail to receive an indicated diagnostic test.
• Equipment failure. Perhaps a battery is dead, or a valve pump doesn't work properly.
• Infections. The patient may get an infection unrelated to the illness while in the hospital, or a surgical site may become infected.
• Blood transfusion-related injuries. A patient may receive blood that doesn't match his or her own blood type.
• Misinterpreted medical orders. A doctor prescribes a "no salt" diet, but the hospitalized patient gets a meal seasoned with salt.

Research indicates that more than half, and maybe as many as 75 percent, of medical errors can be prevented. For example:

• Using computers to order medications and treatments could eliminate problems with not understanding a doctor's handwriting.
• Medicine packages and names should look and sound different to prevent mix-ups and confusion.
• Standard treatment policies and protocols help avoid confusion about what to do and what works best in most cases.

The American Academy of Orthopaedic Surgeons (AAOS) believes that patient safety is a major concern. It is working to reduce medical errors through its Patient Safety Committee. The AAOS and other organizations of healthcare professionals, hospitals and consumers are developing a national plan to measure healthcare quality and ensure accurate reporting of errors. It also has a public education campaign called "Take Care: Patient Safety Is No Accident." Talk to your orthopaedic surgeon about preventing medical errors.