Following today’s news about emergency admissions & hospitalisations a year in England due to medical error, we turn to iatrogenic disease and death

10 Feb

Up-to-date figures for iatrogenic disease and deaths (inadvertently caused by a surgeon or physician or by a medical or surgical treatment or a diagnostic procedure) are not readily available in UK or USA. the US Department of Health and Human Services Office of the Inspector General examining the health records of hospital inpatients in 2008, reported 180 000 deaths due to medical error a year among Medicare beneficiaries alone.

Paul Wearn from the Office for National Statistics – 9 June 2011 – finally answered a FOI request for information about the number of iatrogenic deaths each year: “ONS do not have a National Statistics definition for iatrogenic The causes most closely fitting this concept are ‘complications of medical and surgical care’, ICD 10 codes Y40-Y84. Table 5.19, from the annual ‘Mortality Statistics’ publication shows that there were 236 male deaths and 226 female deaths where the underlying cause was a complication of medical and surgical care, in England and Wales, for 2009”.

In the British Medical Journal (2016, sometinmes requires reader to login) Professor Martin A Makary, department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA explains that a major limitation of the death certificate is that it relies on assigning an International Classification of Disease (ICD) code to the cause of death so causes of death not associated with an ICD code, such as human and system factors, are not captured. can directly result in patient harm and death.

  • communication breakdowns,
  • diagnostic errors,
  • poor judgment,
  • and inadequate skill

Currently, deaths caused by errors are unmeasured and discussions about prevention occur in limited and confidential forums

Hospital committees undertake internal root cause analysis and departments hold morbidity and mortality conferences but these review only a fraction of detected adverse events and the lessons learnt are not disseminated beyond the institution or department.

Strategies to reduce death from medical error should include:

  • making errors more visible when they occur so their effects can be intercepted;
  • having remedies at hand to rescue patients
  • and making errors less frequent by following principles that take human limitations into account
  • death certificates could contain an extra field asking whether a preventable complication stemming from the patient’s medical care contributed to the death.
  • hospitals could carry out a rapid and efficient independent investigation into deaths to determine the potential contribution of error.
  • Standardized data collection and reporting processes are needed to build up an accurate national picture of the problem. 

World Health Organisation statistics show that strategies to reduce the rate of adverse events in the European Union alone would lead to the prevention – on average – of more than 750 000 harm-inflicting medical errors per year, leading in turn to over 3.2 million fewer days of hospitalization, 260 000 fewer incidents of permanent disability, and 95 000 fewer deaths per year.

 

 

 

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