October 7, 2002

The national movement to reduce medical errors is likely to increase the pace of change in health care.

A milestone study released by the Institute of Medicine in 1999 reported that between 44,000 and 98,000 Americans die each year in hospitals due to medical errors. This death rate exceeds that for motor vehicle crashes, breast cancer, and AIDS.

The study estimated that beyond the cost in lives, hospital medical errors also cost the U.S. economy up to $29 billion a year. In the event one is not alarmed by this, more recent studies suggest these numbers may be conservative.

Peter J. Deckers

I am proud to be a product of our nation's medical system. The best in the world, it is a system that yields phenomenal progress every day in healthcare delivery, in biomedical and behavioral science, in the education of health professionals and scientists, and in community service.

Yet for all its strengths, the system is in desperate need of improvement. The increasing attention being given to the twin issues of patient safety and quality of care is, in my opinion, long overdue and well deserved.

Medical errors include adverse drug events, improper transfusions, surgical injuries and wrong-site surgery, suicides, restraint-related injuries, falls, burns, pressure ulcers, and mistaken patient identities. The causes of medical errors are varied and range from language barriers and staff shortages to system fragmentation and complexity.

One in five Americans reports they or a family member have experienced a medical or prescription drug error. Medication errors caused preventable injuries to hospital patients at a rate of about 10 per week at each of two large urban teaching hospitals; one in five were life threatening. Of even greater concern is a study showing that while hospitals are doing a better job of reporting medication errors, they continue to make the same mistakes over and over again.

In response to these studies, employers and other payers are now beginning to hold hospitals to higher standards of quality. The Leapfrog Group, a consortium of more than 100 Fortune 500 companies, and other large private and public health care purchasers, have agreed to base their purchases of health care on more stringent patient safety standards. Since Leapfrog members and their employees spend more than $53 billion on health care each year, the group's standards are changing, or will change, markets. After all, "He who has the gold, makes the rules."

Leapfrog has identified three initial safety standards for hospitals. The first calls for computer physician order entry systems that allow physicians to enter medical orders via computers linked to prescription error prevention software. These systems, when successfully implemented, have reduced serious medical errors by more than 50 percent.

The second standard deals with evidence-based hospital referrals that send patients needing complex medical procedures to hospitals offering the best odds of survival. Risk-adjusted and based on scientifically valid criteria, this referral system could reduce a patient's risk of death by more than 30 percent.

The third standard requires Intensive Care Units to be staffed by physicians with credentials in critical care medicine. This standard has been shown to reduce the risk of death by more than 10 percent.

The Leapfrog Group is now in the process of identifying hospitals that are meeting these standards and educating consumers about preventable medical mistakes. Recently, the state of Massachusetts requested that all hospitals report to their insurance providers whether they meet Leapfrog standards. More states are sure to follow.

Although the costs of implementing Leapfrog's current and future standards will be expensive for hospitals, the initiatives will save considerable sums in the long run. As employers and other payers become more sophisticated and demand more accountability for controlling health care costs, hospitals' participation in programs like Leapfrog will become a necessity.

The special trust that has always existed between patient and health professional has been damaged by headlines that focus on issues related to medical errors and patient safety - things that those of us who are caregivers ultimately control.

To rebuild this trust and remain competitive in the healthcare marketplace of the 21st century, professionals and organizations will need to adopt new ways of thinking, new modes of working, and new kinds of skills. Most of all, there will be demands for new approaches to maintaining our own competence.

If nothing else, consider this to be further evidence that the pace of change in healthcare will continue to increase.

Be peaceful.