Medical errors cause more than 250,000 deaths every year in the United States, enough to make them the nation’s third-leading cause of death if they were recognized in official statistics, experts say.
If the statistical rules change, medical mistakes would trail only heart disease and cancer as a leading cause of US fatalities.
Most medical errors aren’t due to inherently bad doctors, researchers say.
“Incidence rates for deaths directly attributable to medical care gone awry haven’t been recognized in any standardized method for collecting national statistics,” says Martin Makary, professor of surgery at Johns Hopkins University School of Medicine.
Researchers performed their calculations based on eight years of US medical death rate data. The results reflect the fact that national death statistics are derived from a system built for another purpose: generating bills and collecting insurance payments.
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“The medical coding system was designed to maximize billing for physician services, not to collect national health statistics, as it is currently being used,” Makary says. The US Centers for Disease Control and Prevention should adopt updated criteria for classifying deaths on death certificates.
In 1949, the United States adopted an international form that used International Classification of Diseases billing codes to tally causes of death, with no built-in way to collect data on mortality caused by medical care gone wrong.
“At that time, it was under-recognized that diagnostic errors, medical mistakes, and the absence of safety nets could result in someone’s death, and, because of that, medical errors were unintentionally excluded from national health statistics,” Makary says.
For the new study, published in the journal BMJ, researchers examined four separate studies that analyzed medical death rate data from 2000 to 2008, including one by the Department of Health and Human Services’ Office of the Inspector General and the Agency for Healthcare Research and Quality. Then, using hospital admission rates from 2013, they extrapolated that based on a total of 35,416,020 hospitalizations, 251,454 deaths stemmed from a medical error, which the researchers say now translates to 9.5 percent of all deaths each year in the United States.
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According to the CDC, in 2013, 611,105 people died of heart disease, 584,881 died of cancer and 149,205 died of chronic respiratory disease—the top three causes of death in the United States. The newly calculated figure put medical errors behind cancer but ahead of respiratory disease. Non-medical causes of death like accidents are not numerous enough to crack the top three.
“Top-ranked causes of death as reported by the CDC inform our country’s research funding and public health priorities,” Makary says. “Right now, cancer and heart disease get a ton of attention, but since medical errors don’t appear on the list, the problem doesn’t get the funding and attention it deserves.”
Most medical errors aren’t due to inherently bad doctors, and reporting these errors shouldn’t trigger punishment or legal action, the researchers argue. Rather, they say, most errors represent systemic problems, including poorly coordinated care, fragmented insurance networks, the absence or underuse of safety nets, and other protocols, in addition to unwarranted variation in physician practice patterns that lack accountability.
“Unwarranted variation is endemic in health care,” Makary says. “Developing consensus protocols that streamline the delivery of medicine and reduce variability can improve quality and lower costs in health care. More research on preventing medical errors from occurring is needed to address the problem.”
Source: Johns Hopkins University