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Friday, 03 June 2016
Each year, the Centers for Disease Control and Prevention (CDC) compile a list of the leading causes of death in the U.S., based on information recorded on death certificates.
However, medical error does not currently feature on death certificates. This is because there is no International Classification of Disease (ICD) code - a tool used to classify causes of death, adopted in the U.S. in 1949 - assigned to medical error.
"At that time, it was under-recognized that diagnostic errors, medical mistakes and the absence of safety nets could result in someone's death, and because of that, medical errors were unintentionally excluded from national health statistics," explains study co-author Martin Makary, of Johns Hopkins School of Medicine in Baltimore, MD.
Since the ICD system is used to inform mortality statistics for 117 countries - including the U.S., the United Kingdom, and Canada - there is limited data on the number of deaths attributable to medical error.
Medical errors kill more than double the people killed by Motor accidents, firearms and suicides combined!
With the aim of addressing this data gap, Makary and his colleague Michael Daniel - also of Johns Hopkins School of Medicine - analysed the results of four studies that assessed the rate of medical death in the U.S. between 2000-2008.
Medical error is the third leading cause of death in the U.S. after heart disease and cancer
One of these studies, the authors note, was from the U.S. Department of Health and Human Services' Office of the Inspector General and the Agency for Healthcare Research and Quality.
Combining that data with the number of hospital admission rates that occurred in the U.S. in 2013, the researchers estimated that 251,454 deaths occur as a result of medical error each year.
They point out that the CDC list of the leading causes of death in the U.S. puts heart disease at the top (responsible for 611,105 deaths), cancer as the second leading cause (548,881 deaths), and chronic respiratory disease as the third leading cause of death (149,205 deaths).
Therefore, the annual rate of medical error deaths of 251,454 estimated in this study suggests medical error is the third leading cause of death in the U.S.
Based on their results, the authors call for medical errors to be classified as a separate cause of death on medical certificates - a move that would enable researchers and public health organizations to better understand the scale of the problem.
"Top-ranked causes of death as reported by the CDC inform our country's research funding and public health priorities," notes Makary. "Right now, cancer and heart disease get a ton of attention, but since medical errors don't appear on the list, the problem doesn't get the funding and attention it deserves."
In Ireland we keep detailed records of the numbers of dead on our roads. In 2015 a total of 166 people lost their lives as a result of motor accidents. We are ‘horrified’ by these numbers. We take all kinds of measures to reduce these numbers including spending inordinate amounts of money and yet we do not only not make any concerted effort to reduce the numbers but we do not even keep a count of the deaths resulting from preventable medical errors!
Given our medical systems and other contributory factors are by and large similar to those prevailing in the US and the UK, we would expect a similar death ratio to occur here also. How many deaths? An approximate number of annual deaths in Ireland would be in the region of 3530 people! This would not only make it more than 10% of all fatalities, but also the 3rd largest cause of death in Ireland after heart disease and cancer… a pattern identical to that prevailing in the US.
Role of medical error in patient death needs better recognition
As the authors point out, it is impossible to eliminate human error, but they say it is possible to better measure the issue in order to identify ways to reduce medical errors.
As well as recording medical errors on death certificates to achieve this, they suggest death certificates could incorporate an additional field that asks whether a complication leading to a patient's death could have been prevented.
Furthermore, they suggest hospitals could conduct fast and efficient independent investigations upon patient death, in order to determine whether error played a role.