By Tereza Hubkova, M.D.
As committed and hardworking as doctors, nurses, and other hospital personnel are, they are only human, and as such can and do make mistakes. I am not trying to excuse something that can have drastic consequences for patients and their families, but rather embrace a basic fact, thereby opening us to greater understanding as to why these errors happen and how they can be avoided.
It is estimated that each year in the United States roughly 98,000 adult deaths are caused, at least partly, by medical errors. Because medical errors are notoriously under-reported for fear of consequences (e.g., loss of job, lawsuit, etc.), that is likely a conservative figure. According to Reuters Health, one in three people will encounter some kind of mistake during a hospital stay.
Even using the more conservative figures, medical errors rank as the eighth leading cause of death in the United Sates, killing more Americans than motor vehicle accidents, breast cancer, or homicides perpetrated using a firearm. Equally sad is that peoples’ fears of becoming a victim of medical error can cause them to delay or even avoid seeing a doctor, which can prevent them from getting the care they need to stay healthy and alive. But the fears are not unsubstantiated. According to the Journal of the American Medical Association (JAMA) more than two million patients per year are hospitalized after having an adverse drug reaction (ADR); roughly 106,000 of those are fatal. In another study, researchers looked at how many medication administration errors occurred within two departments of a single hospital during the course of a twenty day period. The results were disturbing. The medication administration error rate was 14.9%; of that, 41% involved giving the wrong dose of the medication and 26% the wrong time of administration. 10% of those errors were classified as potentially life-threatening, 26% as significant.
When a nurse is pulled in ten different directions during her shift, trying to juggle the needs of several patients, intravenous fluid pump warnings, patients going to and from various diagnostics and procedures, diabetic patients needing insulin injections before each meal, patients having pain, nausea, diarrhea, difficulty breathing, and all sorts of other big or small emergencies, I can see how the correct timing of medications can be a challenge. There seem to be never enough nurses to do the work, and the demands are high. Nurses are also required to document how all their patients are doing several times per day—mostly for legal purposes. This can be so time consuming, that for all the paperwork, nurses have very little time to actually be with a patient. Admissions and discharges of patients are just as time consuming for nurses as for doctors, and can put other patients on the sidelines for quite some time. Then you have the seemingly never-ending moving of patients from one room to another based on their infectious precautions. I’ll never understand how nurses do all this without more errors; they really deserve our appreciation and gratitude. As much as we like to pretend everything is under control in the hospital, it often is only marginally controlled chaos.
Highlighting the ongoing problems, Medicare no longer pays hospitals to retrieve surgical tools or sponges left in a patient after the initial operation; nor does it reimburse for extra care given to patients harmed by incompatible blood transfusion or air embolisms (i.e., gas bubbles in the bloodstream), for treating bedsores developed in the hospital, for injuries caused by falls in the hospital, infections caused by prolonged use of catheters in the bladder or blood vessels, or a surgical site infection after coronary artery bypass surgery. Hospital administrators, however, argue that some of the conditions are not entirely preventable and that some patients are prone to bedsores no matter how good is the quality of their care. They also worry that the hospital will end up having to absorb the cost of additional laboratory tests on arriving patients, simply to establish whether an infection is already present before a catheter is inserted. But preventable conditions were defined by Medicare with the help of industry experts with the belief that they could reasonably be prevented by following simple evidence-based guidelines. It’s not easy to follow such guidelines, however, if you haven’t slept for twenty-four hours or are supposed to be at four places at once—making quick decisions that can sometimes mean life or death. The extra tests, precautions, and documentation should help improve patient care, but we don’t always take into account the human limits of staff.
I strongly believe that the outrageously high number of reported medical errors is a result of overworked, rather than uncaring or incompetent, staff. As we’ve established, hospital and health care in general in the United States is primarily a business, and to maximize profits, hospitals and clinics are often understaffed (i.e., to minimize personnel expenses), stretching the demands on productivity to unsafe levels— “the more patients you see in an hour, the better, regardless of the quality of such care”. Almost as a rule, there is so little time with and between patients, that doctors and nurses have little time to think about or double check on the orders or results. They just move as fast as they can to the next patient, not by choice, but merely by being forced into the situation by the health care and health insurance systems.
Without scaring you outright, I hope I’ve inspired you to becoming a very savvy, proactive consumer when it comes to your hospitalization, surgery, and health care in general. By now you know that medical errors do happen—having from a mild to a devastating effect on a patient. If you want to do your own research, simply Google the term “medical errors.” You’ll come away with your head spinning. Don’t forget, however, that delaying necessary medical care typically results in more harm than being admitted. It’s how you contribute to minimizing the potential for medical errors that’s your responsibility, and has the greatest impact.
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