Wright - your conclusions about the cause of hospital medical errors are incorrect.
The majority of medical errors in hospitals - falls, bed sores, failure to recognize patient distress - have nothing to do with doctors. These are problems directly related to the number of nurses on a given unit, or more specifically, lack of nursing staff.
Hospitals are not run by physicians, although the lay public and most doctors think they are. Hospitals are run by nurses. A doctor may see a patient for 10 minutes, spend another 20 reviewing the medical record. The nurse is directly responsible for a patient's care for the full 8 or 12 hours of the nurse's shift.
Physicians depend on the nurse to communicate changes in a patient's condition. And it is exclusively the responsibility of the nursing staff to turn patient frequently, get them out of bed, and insure their safety. When nurse-to-patient ratios go down - when there are fewer nurses for more patients - study after study has shown that patient morbidity and mortality goes up.
While there is no question that 24-36 hour shifts for medical residents are ridiculous, not all hospitals, in fact, only big teaching hospitals, have residents, but all hospitals have nurses. However, the amount of hospitals that now have mandatory overtime for nurses is rising, and one can only speculate on how many errors are made during forced 16 or 24 hour nursing shifts.
Medical errors that happen outside of hospitals are due to many factors - too many prescriptions, poor written records, difficulty maneuvering a complex and over-stretched health care system - but blaming hospital medical errors on lack of phyisican oversight is inaccurate.
In most instances of hospital medical errors, the phsyician is irrelevant.
C.MacLean, RN, MS
Patient Protection
The most common medical mistakes and what you can do to avoid them.
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The Institute for Healthcare Improvement estimates there are 15 million instances of medical harm in America every year, and more than 238,000 hospital deaths among Medicare patients between 2004 and 2006 were due to medical mistakes that might have been prevented, according to a recently released study of patient safety in American hospitals by the healthcare rating organization HealthGrades. In California alone, more than 100 incidents of preventable medical harm occur every month, according to the state department of public health. Patient-advocacy groups and regulatory agencies agree that by assuming a more active role in their healthcare, patients can help doctors and other healthcare providers avoid unnecessary errors.
Here are the four most common ways medical care goes awry, and some risk-reducing suggestions.
1. Medication Errors: Four out of every five U.S. adults use over-the-counter drugs, prescription medications or dietary supplements in a given week, and medication errors injure 1.5 million people a year, according to the Institute of Medicine of the National Academies. The causes range from messy handwriting to confusion over similar drug names. The Institute of Medicine recommends that patients maintain complete lists of the medications and vitamins they take and have the lists reviewed regularly by medical practitioners. Ask physicians to explain prescribed medications and their side effects, and have physicians write down dosage information, purpose and how often to take all prescribed drugs.
2. Poor Doctor-Patient Communication:Susan Sheridan co-founded Consumers Advancing Patient Safety in 2003 after her family experienced two medical errors that left her son with cerebral palsy and her husband dead from a malignant tumor that wasn't properly reported to his doctor. Sheridan, who is also a lead member of the World Health Organization's World Alliance for Patient Safety, says that after the mass was removed from her husband's head, it was diagnosed as malignant, but the information never made it back to her husband's doctor, who assumed it was benign. Her son's cerebral palsy stemmed from jaundice, says says, a common condition among newborns but one for which he was not treated.
The Institute of Medicine estimates that patients receive only half the tests and procedures recommended for their conditions. Sheridan emphasizes following up on tests with your doctor and requesting extra copies of lab reports, test results and prescriptions. Electronic record-keeping systems can help patients and doctors better aggregate information and keep personal files. "I collect all my documents and my children's documents and keep their whole history together," she says.
3. Hospital Errors: Bed sores, falls, hospital-acquired infections and failure to aid patients in distress make up the bulk of avoidable errors that occur in hospitals. These errors are often related to an inability on the healthcare provider's part to recognize the patient's need for medical attention. Sheridan recommends that a family member or friend act as an advocate to look out for the patient's best interests. Patient advocates can stay alert for everything from medication errors to patient falls, and in some hospitals, they can also utilize what's known as "Condition H" to alert a quick-response team to the patients' deteriorating condition. The protocol allows patients and their family members to call for immediate help if they feel their condition is not being addressed quickly enough.
4. Surgical Errors: Surgical complications range from known risks to avoidable mistakes, such as transfusing the wrong blood type or administering an incorrect amount of anesthesia. More horrifying, though more rare, are the administrative mistakes: The National Center for Patient Safety reports that 36 percent of mistaken surgeries were performed on the incorrect patient, and up to 2,700 wrong-site surgeries—where doctors bypass the wrong artery or operate on the left ear instead of the right—are performed in America each year, according to the Archives of Surgery. The Joint Commission, an independent healthcare accrediting organization, recommends that patients discuss the operation in detail with their doctors and ask to have the surgical site marked with a permanent marker.
As for healthcare providers themselves, the Joint Commission has issued National Patient Safety Goals that recommend that providers identify and regularly review lookalike and sound-alike drugs and make every effort to distinguish them from each other, identify patients in at least two ways to help prevent mix-ups, and require read-backs of telephone orders and telephone reporting of critical test results.
© 2008
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