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Wednesday, May 17, 2006

Pan American Medical Errors Conference

Patients from across North and South America come together in San Francisco to work against preventable mistakes.
In the United States alone, medical errors cause more deaths each year than breast cancer, car accidents or AIDS, according to a 1999 study by the Institute of Medicine.
Well, maybe. Here is the IOM study, To Err Is Human and the Agency for Healthcare Research & Quality on the issue.

As prestigious as the Institute of Medicine is, peer reviewed work, including the JAMA article cited below, has found a potential overestimation in their figures.

Hayward RA. Hofer TP. Estimating hospital deaths due to medical errors: preventability is in the eye of the reviewer. JAMA. 286(4):415-20, 2001 Jul 25.
Conclusions: Medical errors are a major concern regardless of patients' life expectancies, but our study suggests that previous interpretations of medical error statistics are probably misleading. Our data place the estimates of preventable deaths in context, pointing out the limitations of this means of identifying medical errors and assessing their potential implications for patient outcomes.

[...]

As predicted on theoretical grounds, many deaths reportedly due to medical errors occur at the end of life or in critically ill patients in whom death was the most likely outcome, either during that hospitalization or in the coming months, regardless of the care received. However, this was not the only, —or even the largest, source of potential overestimation. Previously, most have framed ratings of preventable deaths as a phenomenon in which a small but palpable number of deaths have clear errors that are being reliably rated as causing death. Our results suggest that this view is incorrect; —that if many reviewers evaluate charts for preventable deaths, in most cases some reviewers will strongly believe that death could have been avoided by different care; however, most of the "errors" identified in implicit chart review appear to represent outlier opinions in cases in which the median reviewer believed either that an error did not occur or that it had little or no effect on the outcome.
As Hayward and Hofer say, this is in no way to undercut the importance of efforts to limit medical errors which are a serious problem the world over.

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