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Medical mistakes cause significant harm

By: Kelley Talbot

A Johns Hopkins Medicine study concludes that medical error is the third-leading cause of death in the US. It estimates that medical error kills 250,000 Americans every year.

Reactions ranged from astonishment to disbelief when the study was released in May, with some parties questioning the researchers’ definition of error.

The study unleashed a mix of fury from some providers, who felt they were being blamed for systemic failures, patient behavior, and disappointing outcomes for very sick patients. Others called for a focus on reducing mistakes.

One Medscape article captured the flavor of the discussions:

An internist:

A pain management physician:

A pharmacist:

Accurately defining and measuring medical error is a worthy undertaking, with many stakeholders trying to rise to the challenge. And while definitions and estimates vary, there can be little question that medical error is a significant source of patient suffering and death, and that there is room for improvement. That includes not just preventing mistakes in the first place, but improving how they’re handled afterwards.

Of course, the priority is to mitigate physical harm when possible, but there’s also an opportunity to ease patient and family anguish through appropriate communication, apology and empathy.

In Words that Heal, Frenkel and Liebman assert: “Apologies have a potential for healing that is matched only by the difficulty most people have in offering them.”

Rick Boothman, chief risk officer for the University of Michigan Health System, elaborates: “Apologies save money, sure. But more importantly, apologies save lives. It is not just about reducing costs associated with expensive trials. [Apology processes] also train practitioners to take a closer look at preventable adverse events and adjust the processes that caused them. In other words, apologizing and resolving complaints helps prevent future errors.”

Yet, many providers are unwilling or unprepared to have these conversations. Researchers cite fear of liability, concerns about hurting providers’ professional reputation and difficulty acknowledging responsibility, and lack of training to lead these discussions.

Now, initiatives to find a better approach are underway.

At the Veterans Affairs Medical Center in Lexington, KY, errors are disclosed, apologies are made, and settlements are offered. “The hospital reports that the policy has resulted in improved relationships with patients, faster settlement of claims, and decreased litigation costs,” explains Jennifer Robbennolt in Apologies and Medical Error.

AHRQ recently released its CANDOR (Communication and Optimal Resolution) process toolkit for responding to medical errors. The model requires a shift away from “deny-and-defend” towards one that includes identifying errors, disclosure and response to patients and other stakeholders, and investigation and analysis aimed to prevent future mistakes. The MedStar health system – which piloted CANDOR – reports that its rate of serious safety events has been cut in half since it began using CANDOR principles.

Credit: AHRQ.gov

While acknowledging there is a long way to go in terms of refining similar models, gaining buy-in, and implementation, supporters say the potential benefits — fewer errors, reduced costs, and faster resolution of events — are worth pursuing. Benefits that healthcare communication professionals must play a significant role in realizing.