Are we measuring preventable medical errors in our hospitals?
A recently published article in the British Medical Journal by Martin Makary and Michael Daniel lists medical errors as the third leading cause of death in the United States.
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The analysis leading to this conclusion is interesting, especially since medical errors are not acknowledged within the International Classification of Diseases (ICD) codes used in over 117 countries to code mortality statistics. Deaths arising from system or human factors are therefore not captured.
The views of the authors are also revealing as they enable other healthcare systems, including Ghana, to extrapolate the basic assumptions for quantifying the contribution of medical errors to our own setting in order to measure harm and thus set up systems to avert it.
The article described medical error as “ an unintended act (either of omission or commission) or one that does not achieve its intended outcome, the failure of a planned action to be completed as intended (an error of execution), the use of a wrong plan to achieve an aim (an error of planning), or a deviation from the process of care that may or may not cause harm to the patient.” (Reason JT)
Measuring errors
In 1993, Leape, a Harvard Scientist, argued that 78 per cent and not 51 per cent of 180, 000 iatrogenic deaths or deaths related to the medical examination or treatment, and captured in a previous study, were due to medical errors. Through examination of patients’ records, the US Department of Health and Human Services Office of the Inspector General attributed 180, 000 deaths in 2008 alone to medical errors. Landrigan, another scientist in a six year study reported that 63 per cent of deaths among in-patients were attributable to medical errors.
Of course, the practice of making projections based on extractable patients’ records may be challenged in systems where comprehensive and accurate patients’ records are not a matter of course. This may be either because there is no accountability for professionals to keep such records or even if kept, are undermined by botched filing systems. However, although limiting the measurement strategy to only data gleaned from patient records raises the possibility of under reporting, it is certainly a good starting point even in Ghana where routine measurement of harm and medical errors is not standard practice.
Human error is inevitable. As a medical practitioner, I can recount episodes where human errors have endangered lives. I recall an instance where my prescription of anti-snake potion for a little boy bitten by a snake almost sent him to his grave faster than the snake bite itself. As it turned out, the anti-snake potion had long expired and but for alert monitoring and swift intervention, we would have lost him. Many instances exist where medicines with similar sounding names have been interchanged with disastrous consequences.
The point then is to design safer systems that according to the journal “mitigates its frequency, visibility, and consequences. Strategies to reduce death from medical care should include three steps: 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.”
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To do the above however, we need to know the extent of the problem through improved measurement and transparent sharing of data around medical errors in order to design better systems of care. We need to do a better job of measuring adverse events arising out of our medical interventions. We need to do a good job of documenting the lessons from our morbidity and mortality reviews and a better job of disseminating and implementing the lessons and key interventions, respectively, across multiple systems of care. Additionally the authors propose an amendment to standard death certificates where “Instead of simply requiring cause of death, death certificates could contain an extra field asking whether a preventable complication stemming from the patient’s medical care contributed to the death.”
Overall, I totally agree with Martin Makary and Michael Daniel that medical errors are under-recognised, even in Ghana. For this purpose, I advocate the Ministry of Health, working through health professionals in service agencies such as the Teaching Hospitals, Ghana Health Service, Christian Health Association of Ghana, etc. to begin to provide sound advice as to how we can operationalise our definition of medical errors, measure the extent of harm in our hospitals and transparently share this data with the view to redesigning safer systems in a non-punitive environment.