Hospitals have signed on to a six-part plan to avoid a multitude of unnecessary deaths
Before 1999, dying in a hospital because of shoddy care was a real enough possibility, but only the paranoid or pessimistic gave it much thought. Then came To Err Is Human, a j'accuse-style thunderbolt from the prestigious Institute of Medicine. Medical errors in hospitals, charged the institute's report, kill at least 44,000 and perhaps as many as 98,000 patients a year. On its heels, other studies found widespread failure to heed well-known "best practices" that could save lives. Horrific tales of individuals betrayed by mistakes and inattention popped up in the news like poisonous mushrooms. Medical centers suddenly were seen as death traps.
In truth, no one knows now, or knew with any precision in 1999, how many hospital patients die from errors and inadequate care. Even agreement on the meaning of "error" is elusive--should deaths caused by substandard care be counted along with deaths caused by mistakes?
It's also important to maintain a sense of perspective. Suppose the institute's higher estimate is right and is rounded up to 100,000. Here's what it means to you when that number is placed alongside total yearly hospital admissions of about 37 million: The arithmetic works out to roughly one death from medical errors for every 370 admissions. Or, to put it another way: A patient undergoing major surgery probably faces a risk of dying, if everything goes right, of 2 percent or more. Including the worst-case possibility of death due to a mistake adds about one quarter of 1 percentage point to this risk.
Careless care . This view provides no comfort, of course, if you are a friend or family member of someone who needlessly died in a hospital. And although the IOM report called for an all-out improvement effort, it just hasn't happened. Hospitals in the wealthiest nation on the planet are still killing tens of thousands of people every year by infecting them after surgery, mixing up their medications, treating them with entrenched, outdated medical practices, or reacting too slowly when they show danger signs.
Robert Wachter, a longtime safety and quality expert and chief of the medical service at the University of California, San Francisco Medical Center, calls it an epidemic that most hospitals still don't take seriously until a high-profile disaster occurs on their watch. "Show me a medical organization," he says, "that really has walked the walk when it comes to safety and has not [itself] made a terrible error."
There's been plenty of talk about safety, and even meaningful activity. The federal Centers for Medicare and Medicaid Services began posting performance numbers showing how well more than 4,200 hospitals comply with basic guidelines for treating heart attack, heart failure, and pneumonia (www.HospitalCompare.hhs.gov). The accrediting body for hospitals, the Joint Commission for Accreditation of Healthcare Organizations, has added new patient safety requirements year by year. Safety and quality initiatives pioneered by organizations such as the Leapfrog Group and the National Quality Forum have been hammered out.
But if these efforts have had an effect beyond a handful of medical centers, it's hard to see. "It's a question of leadership," says Donald Berwick, president and chief executive of the Institute for Healthcare Improvement in Cambridge, Mass. Since 1991--nearly a decade before the Institute of Medicine's error report--he has proselytized for grass-roots-level quality improvements in hospitals. "They must do better. 'Trying harder' is the world's worst plan."