A new study published in BMJ Tuesday suggests that if experts classified medical error as a disease, it would be the third leading cause of death in the United States.
Helmed by researchers at Johns Hopkins University, the paper estimates that medical errors cause 250,000 deaths a year, surpassing chronic lower respiratory diseases—the third leading cause of death—by more than 100,000. The authors blame limitations in death certificates for the lack of accurate data on the topic, and suggest the way fatalities are reported be revised.
Medical error is loosely defined as a “preventable adverse effect of care, whether or not it is evident or harmful to the patient.” The authors of the BMJ study cite specific types of error, which include “the use of a wrong plan,” “the failure of a planned action to be completed as intended,” and “an unintended act.”
It’s a phenomenon that’s virtually invisible in death statistics due to the United States reliance on what’s called the International Classification of Disease (ICD). Approved by the World Health Organization (WHO), it is used by 117 countries worldwide as a standard diagnostic tool for measuring mortality and morbidity statistics.
The system provides specific codes that correspond to causes of death, but leaves no room for physicians or others to denote a cause that resulted from a medical shortcoming. As a result of this limitation, there is no way to track how much medical error plays into the death rate worldwide.
Studies on the amount of deaths caused by medical error in the U.S., as a result, have been scant. The “seminal” study on the topic, as far as science is concerned, is a 1999 paper from the Institute of Medicine (IOM), which the authors call “limited and outdated.” The report estimates anywhere from 44,000 to 98,000 deaths per year from medical error.
Since 1999, several more studies on the topic have been released; one in 2008 suggested that as many as 400,000 people die a year from this cause. To update the current number, the researchers combined all of the studies since 1999 and performed a weighted analysis. The result: a mean rate of 251,454 deaths per year from medical error.
Martin A. Makary, the leader of the study and an oncologist at Johns Hopkins, attributes the lack of knowledge surrounding the issue to the CDC’s failure to create a system in which deaths due to medical care could be catalogued.
“Currently, deaths caused by errors are unmeasured and discussions about prevention occur in limited and confidential forums, such as a hospital’s internal root cause analysis committee or a department’s morbidity and mortality conference,” writes Makary. “These forums review only a fraction of detected adverse events and the lessons learnt are not disseminated beyond the institution or department.”
The researchers give one example case of a death caused by medical error, that of a “young woman” who had successfully recovered from a transplant surgery. A few days after going home, she came back to the hospital with “non-specific symptoms.” At that point, doctors performed “extensive tests,” some of which the authors deem “unnecessary.”
When she returned days later, she was suffering from 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 authors write. “The death certificate listed the cause of death as cardiovascular.”
Stories like these, says Makary, perfectly capture the problem with death statistics, and highlight the need for both the U.S. and the World Health Organization to pursue a better system.
“Sound scientific methods, beginning with an assessment of the problem, are critical to approaching any health threat to patients. The problem of medical error should not be exempt from this scientific approach,” Makary writes in the conclusion. “More appropriate recognition of the role of medical error in patient death could heighten awareness and guide both collaborations and capital investments in research and prevention.”
The Centers for Disease Control and Prevention could not be reached for comment.