Medical Errors Cost Economy $20 Billion

The Society of Actuaries is an educational, research and professional organization dedicated to serving the public, its members and its candidates. The SOA's mission is to advance actuarial knowledge and to enhance the ability of actuaries to provide expert advice and relevant solutions for financial, business and societal problems. The SOA's vision is for actuaries to be the leading professionals in the measurement and management of risk.

Findings from a new study released by the SOA estimate that measurable medical errors cost the U.S. economy $19.5 billion in 2008.  The study shows how 1.5 million medical errors compromise quality of American healthcare and cause unnecessary waste in the system

Commissioned by the Society of Actuaries (SOA) and completed by consultants with Milliman, Inc., the report used claims data to provide an actuarially sound measurement of costs for avoidable medical injuries. Of the approximately $80 billion in costs associated with medical injuries, around 25 percent were the result of avoidable medical errors.

Jim Toole, managing director of MBA Actuaries, Inc., said  "Of the $19.5 billion in total costs, approximately $17 billion was the result of providing inpatient, outpatient and prescription drug services to individuals who were affected by medical errors. While this cost is staggering, it also highlights the need to reduce errors and improve quality and efficiency in American healthcare."

Medical errors are a significant source of lost healthcare funds every year. For example, the study found that $1.1 billion was from lost productivity due to related short-term disability claims, and $1.4 billion was lost from increased death rates among individuals who experienced medical errors. According to a recent SOA survey, which identified ways to bend the national healthcare cost curve, 87 percent of actuaries believe that reducing medical errors is an effective way to control healthcare cost trends for the commercial population, and 88 percent believe this to be true for the Medicare population.

"We used a conservative methodology and still found 1.5 million measureable medical errors occurred in 2008," says Jonathan Shreve, FSA, MAAA, consulting actuary for Milliman and co-author of the report. "This number includes only the errors that we could identify through claims data, so the total economic impact of medical errors is in fact greater than what we have reported."

Key findings from the study include:

There were 6.3 million measureable medical injuries in the U.S. in 2008; of the 6.3 million injuries, the SOA and Milliman estimate that 1.5 million were associated with a medical error.
The average total cost per error was approximately $13,000.  
In an inpatient setting, seven percent of admissions are estimated to result in some type of medical injury. The measurable medical errors resulted in more than 2,500 avoidable deaths and more than 10 million excess days missed from work due to short-term disability.

The study also identifies the 10 medical errors that are most costly to the U.S. economy each year. Approximately 55 percent of the total error costs were the result of five common errors:

Pressure ulcers
Postoperative infections
Mechanical complications of devices, implants, or grafts
Postlaminectomy syndrome
Hemorrhages complicating a procedure

The SOA and Milliman findings were based upon an analysis of an extensive claims database. Measureable costs of medical errors included increased medical costs, costs related to increased mortality rates, and costs related to lost productivity of an error.

 


 

Medical Errors as "Never Events"

The National Quality Forum has studied and evaluated medical errors.  They have created a limited number of "never events" meaning, of course, that they should never happen.   See article here.   Most of these mistakes happen while a patient is being cared for in a nursing home.

Here are some that you often see in nursing home litigation: 
-Patient death or serious disability associated with the use or function of a device in patient care in which the device is used or functions other than as intended 
-Patient death or serious disability associated with patient disappearance for more than four hours 
-Patient death or serious disability associated with a medication error 
-Patient death or serious disability associated with hypoglycemia, the onset of which occurs while the patient is being cared for in a healthcare facility 
-Stage 3 or 4 pressure ulcers acquired after admission to a healthcare facility 
-Patient death or serious disability associated with a burn incurred from any source while being cared for in a healthcare facility
-Patient death associated with a fall while being cared for in a healthcare facility
-Patient death or serious disability associated with the use of restraints or bedrails while being cared for in a healthcare facility 
-Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist, or other licensed healthcare provider 
-Sexual assault on a patient within or on the grounds of a healthcare facility
-Death or significant injury of a patient or staff member resulting from a physical assault (i.e., battery) that occurs within or on the grounds of a healthcare facility

To learn more about this list, and the criteria for including a medical error on this list, visit the Center for Medicaid and Medicare Services website.

 

12 Most Common Medical Errors (And How to Prevent Them)

Ashley M Jones wrote on the Pharmacy Technician Certification blog the following article on the 12 most common medical errors and how to prevent them.  Many of these errors occur in nursing homes every day.

According to the National Academy of Sciences, medical errors injure millions of people each year and cost billions of dollars annually in increased health costs. And this does not take into account lost wages or productivity costs. If that isn’t frightening enough, the Institute for Healthcare Improvement estimates that more than 238,000 hospital deaths among Medicare patients between 2004 and 2006 were due to medical errors that could have been prevented.

With healthcare reform front and center in political discussions, but little coming from it, patients are left to rely on their overworked physicians and other caregivers for reliable services. To best avoid becoming part of the statistics, become part of the solutions by knowing the 12 most common medical errors and how to prevent them.

1. Medication Errors : The most common of medical errors, luckily it can be one of the most preventable. Errors include assigning a medication due to improper information such as allergies, other medications taken, previous diagnosis, and others. A medication error can also include lack of up to date warning or miscommunication due to poor handwriting. There is also confusion among drugs with similar names or dosage, and this effects all drugs including prescription, over the counter, vaccines, etc. The best way to avoid this medical error is to know what you’re taking, how much, and what you can’t take. If unable to remember, bring all of your medications to the doctor or hospital with you.

2. Bad Communication :  Have you been going to the same doctor for years? That doesn’t mean that he or she knows or will remember everything about you. The second most common medical error results from poor doctor/patient communication. With loads of tests and labs, doctors will not always remember every test you have, so it is up to you. The Agency for Healthcare Research and Quality lists the ten questions every patient should ask their doctor, along with many other useful tips. You can even go there to build your own personalized question list.

3. Infection : They may seem clean, but hospitals are one of the most likely places to receive an infection. Given the high incidence of people with infections, workers who can become contaminated, and the fact that many patients enter the hospital with weakened immune systems, infection can be a serious problem. If staying at a hospital, be sure to avoid a doctor’s tie, ask him or her if they have washed their hands since visiting the last patient, and be sure to wash your own often. This article reports on the incidence of high IV infection rates. If you receive one, be sure to monitor for signs of infection and ask for a new one if suspicious.

4. Falls : Because on so many new drugs, patients cannot predict how they will react to them, causing a fall, which is another leading common medical error. In fact, ten percent of falls for the elderly occur in hospitals. Patients who have other mobility issues like a broken leg, walker, or cane, can also find the clean hospital floors more slippery than those at home. If you think you need assistance standing and walking, contact the nursing staff. Be sure and allow 10-20 minutes for a response, as they may be busy assisting others stand and walk.

5. Surgical Errors : Because surgery is scary enough when everything goes right, it is vital to prevent errors before, during, and after. These can include wrong site, wrong procedure, and even wrong patient surgeries. Although there are new procedures in place to reduce these common medical errors, you can still do your part. Speak to your surgeon about the procedure you are having, why you are having it, and what the surgeon will be doing during the surgery. Also know the rules in place to avoid surgical errors: 1. The surgeon must sign the incision site with the patient awake. 2. Use only a signature and not a confusing “X.” 3. The entire surgery team must stop and perform a checklist before beginning the procedure.

6. Pharmacy Errors : You don’t have to be in a hospital to be a victim of a common medical errors. With dozens of patients each day, pharmacies can also make errors on your medication. In fact, according to this article from CNN, 30 million Americans are the victim of outpatient medication errors each year. Although some are minor and can be caught easily by most patients, others are not. To best prevent medical errors of this sort, know what your doctor prescribed and how much when going to the pharmacy. Also, be sure to be honest with the pharmacist about other medications and drugs you are taking to ensure that there is no harmful interaction.

7. Lab Errors : Another facility with many patients and tests in one spot, common medical errors can occur here as well. These can also be truly devastating by leading to wrong diagnosis and wrong treatment, while the initial disease continues. Types of common errors can include MRI or CT taken incorrectly, samples taken incorrectly, or results misinterpreted. If you feel your lab results are misleading, you are within your rights to ask for another lab test to confirm.

8. Treatment Errors : If you feel your diagnosis was reached correctly, a common medical error can still happen during treatment. Because many doctors have been practicing for decades, it is not unusual for them to be using outdated procedures. Be sure to ask why you are having the treatment, how long the doctor has been doing them, and if there are any alternatives. This website is full of guidelines for treating many common illnesses.

9. Follow Up Care : When discharged from the hospital or clinic, be sure and know what your follow up care is and what to expect from it. If you are given a specific amount of medication and told to take it all, take it all. Just because you feel better halfway through, doesn’t mean you are better. Ask the facility who to contact if you have follow up questions on your at home care. This link also has more on what to do.

10. Birth Injuries : It may be the most joyous time in your life, but birthing a child can also lead to medical errors. The most common can result in serious injuries such as cerebral palsy and paralysis. Women who are most at risk include those with large babies, prematurity, prolonged labor, and more. To best avoid these injuries, do research on the place you would like to have your baby in. Check several hospitals in and outside of your area. See the incidence of birth injury and, if possible, read reviews by other mothers who gave birth there.

11. Bring Family : This is vital to avoiding common medical errors. If you are too ill to answer or too tired to protest, an informed family member is your best bet to sidestepping a common medical error. They can answer questions about medications, do reviews of your current and future care, and lift spirits. Make sure they also read these 12 most common medical errors and how to prevent them. Click on this link to get more rules for family members visiting at a hospital.

12. Don’t Wait Until It’s Too Late : With healthcare costs on the rise, many patients believe they can save money by putting off the doctor’s visit. However, this can actually have the opposite effect as the worse a disease gets, the harder and more expensive it is to treat. This decision can also be deadly with the wrong disease going undiagnosed or treated. If you have no insurance, find a Take Care Clinic. Visits start at $65, which is far cheaper than many primary care visits out of pocket. They are also doing free blood glucose testing for the month of February.

If you have any questions regarding the above 12 most common medical errors and how to prevent them, ask your physician. The best way to not become lost in a system like so many million before you is to be your own best advocate. Know your rights both as a patient and an insurance holder. If you don’t have insurance, there are still many resources for you, along with many useful tips for those who do have it.
 

Need for transparency with health care errors

The Philadelphia Inquirer wrote an article about how many errors in health care settings do not get reported.  These errors or mistakes, whatever you want to call them, need to be disclosed so we can figure out how to prevent them in the future.  These health care businesses are more worried about getting caught then preventing them.

The article describes several incidents where patients were not given proper care but the hospitals failed to report the problems such as two patients at Fox Chase Cancer Center in Philadelphia required additional surgery after objects were negligently left inside their bodies or three patients at Mercy Fitzgerald Hospital had to be sent back to the OR last year to stop excessive postoperative bleeding or  At Abington Memorial Hospital, an elderly woman recovering from surgery for a broken hip in 2005 was left on a bedpan for at least 41/2 hours. She developed two open bedsores as a result.

For several years now, hospitals in Pennsylvania and New Jersey have been required to report medical mistakes and serious complications to state agencies charged with reducing medical errors. But most hospitals aren't complying, undermining efforts to improve patient safety.  In New Jersey, five of the state's 80 hospitals failed to report a single preventable mistake last year. In Pennsylvania, some facilities didn't report any serious events or even the near misses that might have harmed patients.

James Bagian, head of the Department of Veterans Affairs' National Center for Patient Safety, said: "Anybody that is supposed to report close calls and has zero reports is clueless; Management is asleep at the switch and just waiting until they kill someone."  The public can only learn that a hospital isn't reporting mistakes in those rare instances when the health department cites it for failing to comply with the law.

"There is still some underreporting, and we are working directly with the hospitals to understand why," said Eliot Fishman, policy director of the New Jersey Department of Health and Senior Services.  Consumer advocates want more transparency so patients can make better health-care decisions.

The numbers suggest underreporting is more than just a passing problem.   Calvin Johnson, the Pennsylvania secretary of health, said only people with their "head in the sand" would fail to see the problem of uneven reporting by hospitals. But he noted that with about 200 hospitals and millions of patient visits each year, it is impossible for the state to check every chart.

While it's important to study each of those reports, it is at least as crucial to identify hospitals that are not participating at all, said Conway, of the health-care improvement institute.   "We cannot improve care unless we understand the problems," Conway said. "There can't be safety without transparency."
 

Need for transparency with health care errors

The Philadelphia Inquirer wrote an article about how many errors in health care settings do not get reported.  These errors or mistakes, whatever you want to call them, need to be disclosed so we can figure out how to prevent them in the future.  These health care businesses are more worried about getting caught then preventing them.

The article describes several incidents where patients were not given proper care but the hospitals failed to report the problems such as two patients at Fox Chase Cancer Center in Philadelphia required additional surgery after objects were negligently left inside their bodies or three patients at Mercy Fitzgerald Hospital had to be sent back to the OR last year to stop excessive postoperative bleeding or  At Abington Memorial Hospital, an elderly woman recovering from surgery for a broken hip in 2005 was left on a bedpan for at least 41/2 hours. She developed two open bedsores as a result.

For several years now, hospitals in Pennsylvania and New Jersey have been required to report medical mistakes and serious complications to state agencies charged with reducing medical errors. But most hospitals aren't complying, undermining efforts to improve patient safety.  In New Jersey, five of the state's 80 hospitals failed to report a single preventable mistake last year. In Pennsylvania, some facilities didn't report any serious events or even the near misses that might have harmed patients.

James Bagian, head of the Department of Veterans Affairs' National Center for Patient Safety, said: "Anybody that is supposed to report close calls and has zero reports is clueless; Management is asleep at the switch and just waiting until they kill someone."  The public can only learn that a hospital isn't reporting mistakes in those rare instances when the health department cites it for failing to comply with the law.

"There is still some underreporting, and we are working directly with the hospitals to understand why," said Eliot Fishman, policy director of the New Jersey Department of Health and Senior Services.  Consumer advocates want more transparency so patients can make better health-care decisions.

The numbers suggest underreporting is more than just a passing problem.   Calvin Johnson, the Pennsylvania secretary of health, said only people with their "head in the sand" would fail to see the problem of uneven reporting by hospitals. But he noted that with about 200 hospitals and millions of patient visits each year, it is impossible for the state to check every chart.

While it's important to study each of those reports, it is at least as crucial to identify hospitals that are not participating at all, said Conway, of the health-care improvement institute.   "We cannot improve care unless we understand the problems," Conway said. "There can't be safety without transparency."
 

JCAHCO Sentinel Events Statistics


Updated sentinel event statistics

The Joint Commission’s sentinel event statistics have been updated on The Joint Commission website. Since the sentinel event database was implemented in January 1995 through June 30, 2008, The Joint Commission has received 5,208 reports of sentinel events. A total of 5,336 patients were affected by these events, with 3,713, or 70 percent, resulting in patient death. The 10 most frequently reported sentinel events are:

Wrong-site surgery                                    691
Suicide                                                         641
Operative/post-operative complication  598
Medication error                                          470
Delay in treatment                                       390
Patient fall                                                     307
Assault, rape or homicide                         198
Patient death or injury in restraints         183
Unintended retention of foreign body*    175
Perinatal death or loss of function           159


* Added to reviewable events in June 2005; data represents events reviewed since that time.

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