Sample Essay on Medical Error in the United States
Medical errors have constituted to over 98,000 deaths annually in the United States. This confirms an argument that healthcare in the country is not as safe as it is supposed to be. Patient safety and healthcare quality have been the main areas of focus for improvement purposes in the past few years. Medical errors result when planned actions fail to deliver the expected outcomes, or when a wrong plan is implemented to achieve particular objective. Improper transfusions, unfavorable drug effects, wrong-site surgeries, surgical errors, burns, mistaken patient identities, suicides, and restraint-related injuries, are among many problems that may occur in healthcare. Reports such as “To Err is Human” and “Crossing the Quality Chasm” confirm the existence of medical errors in the United States and the effects it has had over patients. These publications brought awareness to the public, governments, medical societies, and healthcare providers around the world. This was viewed globally as a threat to public health in every part of the globe.
The public was made aware of the inadequacies of the only place that is supposed to make them feel better and safe. This brings about fear and doubts on the healthcare systems, concerning the safety of patients, and ability to deliver effective services. Government and medical institutions started taking measures that would ensure that the quality of healthcare is improved. Facilities that would facilitate error reporting were established in both the United States and Australia, in the year 2000. Other countries that followed in these footsteps include the United Kingdom in 2003 and France later on in 2006. The main aim of the healthcare community is to restore public confidence in the health care system by improving quality. Initially, the aspect of quality in healthcare was limited to the physician-patient relationship. However, the emerging issues of medical errors have escalated this to a point where the entire health community is involved. Issues to do with the quality of healthcare now incorporates the ethical access to care, reactivity of caregivers, security of the care, efficiency, and satisfaction of the patient.
Medical errors in healthcare have escalated to a global level epidemic. There are several factors that contribute to the occurrence of these preventable errors. The main factor is the nature of the healthcare delivery system, which is decentralized and fragmented. A patient may visit different health providers, none of which who has access to complete information, thereby creating a room for errors to be made. The licensing and accrediting processes of healthcare providers also plays a significant role in the creation of avenues for medical errors. These processes tend to focus minimal attention towards the prevention and management of medical errors. Even these minimal efforts face resistance confrontations from some healthcare providers and organizations. The healthcare organizations and providers lack the required finances and support needed to improve safety and quality.
Patients in the Intensive Care Unit (ICU) are subject to more medical errors than any other patient admitted in the hospital. This is as a result of the many complexities surrounding their conditions. Therefore, continuous attention is required in the prevention of errors associated with ICU patients. This paper aims determining the real definition of safety and its measurement tools, identifying indicators for routine monitoring, developing and evaluate prevention strategies. The impact of medical errors to patients and their relatives is also covered. Medical errors also have other effects apart from the usual costs on human life. Preventable medical errors have been argued to result in losses of over $17 to $29 billion annually in the hospitals. These errors also have an impact on the image of hospitals and the entire healthcare system as a whole. This is due to the mistrust by the patients or their relatives that results from diminished satisfaction. There is also a huge cost to the patients themselves, for example, a patient who receives longer hospital stays or end up with disabilities, caused by medical errors. The costs to these patients are in form of psychological and physical discomforts. Health professionals are also affected, as there is a loss of morale and frustrations resulting from the notion that they are incapable of providing good quality healthcare. The society as a whole also pays the price of medical errors, as the health status of the population lowers. This translates to high school dropouts among the children, low performance by workers, leading to low growth.
Literature review
The quality of healthcare has been under review since the 19th century. For instance, in the 1850s, Florence Nightingale studied mortality rates in hospitals during the Crimean war. In 1912, a method that could measure outcomes of surgeries was developed by Codman. Standards for hospital accreditation were defined by the American College of Surgery in 1918. The 50s entailed the development of the medical audit method in the United States by P. Lembcke. Also, the Joint Commission on Accreditation of Hospitals (JCAH) was formed. Its main purpose was to accredit hospitals that had met all the quality standards. Through the use of questionnaires and patient chart reviews, J. Williamson developed a method of assessing whether the healthcare system was living up to its full potential, and how much more it can achieve in 1970. Avedis Donabedian also contributed to the healthcare system, back in 1922 by applying the industrial model of Structure, Process, and Outcome Measures to healthcare. These are among the many contributions made over the years towards quality improvement in healthcare.
According to Quality of Health Care in America Committee of the Institute of Medicine (IOM) issue a report in November 1999 that placed the number of deaths as a result of medical error between 44,000 and 98,000 annually. This is unacceptable, considering that the healthcare system is intended to offer comfort and healing to patients. The publication used the available data on mortality as a result of medical errors, highlighted the potential causes of medical errors, and also, proposed strategies that can be adopted in order to mitigate these errors. The report addresses the entire medical practice as a whole; however, most of its findings are applicable to cardiology practices. It also includes the Error-tracking Systems, although they were at their infancy stages. According to the medical literature contained in the publication, the report concludes that medical errors are a menace in the United States, and are among the leading causes of deaths. According to the IOM, systematic problems that result in medical errors outweigh errors caused as a result of poor performance by individuals.
Other publications have been released over time supporting the findings of the IOM. For instance, a report on inpatient deaths was submitted in 2004 by the Agency for Healthcare Quality and Research Patient Safety Indicators in the Medicare population. According to the report, there were a total of 575,000 deaths between the year 2000 and 2002, all caused by medical errors. This translated to a staggering 195,000 deaths per year. The United States Department of Health and Human Services Office the Inspector general also carried about a similar research on medical errors in the United States in 2008. The report revealed a total of 180,000 annual deaths as a result of errors in healthcare delivery. A research done by Classen et al (2013), also showed a mortality rate of 1.13%. When this rate is applied to the total number of hospitals in the United States, it translates to over 400,000 annual deaths.
Landrigan et al carried out a research that involved a group of hospitals in North Carolina between 2002 and 2007. According to the submitted report, 0.6% of all hospital admissions experienced lethal adverse events. 63% of these lethal adverse events were as a result of medical errors (Stelfox et al, 2006). This translates to over 134,581 deaths annually. Hayward et al, (2001), also took part in the research of medical errors. He applied a weighted analysis in estimating the range of preventable adverse occurrences. The results showed a range of between 210,000 and 400,000 deaths happening annually as a result of medical errors. All these publications confirm the fact that medical errors are a leading cause of deaths in the United States. ICU patients have been found to be the most affected by medical errors. This study aims focuses on ICU patients, safety issues, and ways through which these errors can be dealt with.
Methodology
Safety
To start with, a clear definition of safety is required. According to safety can be defined as the freedom from injuries or any harm that may result from errors being made in terms of planning or execution of a planned course of action (Hayward et al, 2001). Planning errors entail making mistakes by for example, choosing and implementing the wrong plan with aims of achieving a certain goal. The error of execution entails the failure of a planned course of action to be completed or bring forth the expected outcomes. Execution errors can further be classified as errors of omission or commission. Omission errors entail not doing the right thing but unintentionally. Errors of commission entail doing the wrong thing unintentionally. These errors are common in all steps of the healthcare processes such as the diagnosis stage, treatment stage, and prevention stage. Errors may or may not result in unfavorable events. These unfavorable events are injuries that may harm the patient resulting from medical intervention. Harm to the patient may come in form of prolonged stays at the hospital, disabilities, life-threatening illnesses, and also death. Adverse or unfavorable events may result from medical errors or other factors. In the case of medical errors they can be prevented.
Measuring Safety
Two basic approaches are used in the evaluation and improvement of healthcare quality. The first approach is the room-for-improvement model. This model entails the identification of problems, development of plans that will be used to deal with the problems, and the assessment of the plan’s effectiveness. The approach is referred to as the Plan-Do-Act Cycle (PDAC), formulated by the Institute for Healthcare Improvement. The second approach entails using a monitoring system to detect problems, and uses quality indicators to evaluate the problems periodically (Brennan, 2000). These two approaches are complimentary and are mostly used concurrently. The monitoring approach helps in seeking improvement opportunities, after which the PDAC is initiated. A self-assessment system is used in safety measurement for quantifying actions, so as to identify the potential areas of improvement. A good surveillance system would be able to apply different methods to identify medical errors and their adverse effects. These surveillance systems apply the different methods in both the national and local levels. At the national level, the National government has reporting systems in place. At the local level, hospitals, and both public and private agencies have developed and implemented patient safety and quality improvement programs. These programs include databases that facilitate the reporting of adverse events. For example, in North America, the Patient Safety and Improvement Program was developed in 2005. In 2008, Europe introduced the Europeans Network for Patient Safety (EUNetPAS). The EUNetPAS was aimed at instilling a culture of patient safety in the healthcare system, and also, providing a patient safety education and training framework. The EUNetPAS was also aimed at implementing a curriculum on patient safety and reporting systems (Hayward et al, 2001).
There are different reporting systems that can be utilized at the hospital level. For instance, the medical review can be used to focus on selected indicators. The indicators can be assessed using mortality review data, discharge summaries, and administrative data. Another reporting system readily available for hospitals is voluntary reporting. This system is however clouded by limitations such as fear of litigation, inadequate reporting system, reluctance to report one’s own errors, among others. Observation is also one of the widely used methods for error detection in hospitals. A combination of all the above error detection methods among many others, helps to determine the nature of care delivery ICU patients receive globally. These systems include the use of indicators to determine medical errors.
According to Stelfox et al (2006), there are a total of three categories of indicators. They include structure indicators, process indicators, and outcome indicators. Structure indicators of quality help in comparing the current level of quality with the desired quality level. The process indicators are used to compare the taken courses of action with the required courses of action. The outcome indicators compare the achieved outcome with the excepted outcomes. There are several factors that determine the choice of safety indicators. They include monitoring methods, previous quality indicators used, process monitoring aimed at ensuring the outcome monitoring process is effective, and the availability of time to include more indicators.
For the purpose of this study, a list of 180 adverse events in the ICU was compiled into one list after they were derived from the electronic MEDLINE database. This involved a search of keywords such as “intensive care unit,” “adverse events,” “medical errors,” “epidemiology,” and “iatrogenic.” The list was then sent to experts working in 5 different ICU fields. The fields included neurology, gastroenterology, cardiovascular disease, pulmonology, and nephrology. The ICU experts added 415 more adverse events. 30 more experts, including nurses, were selected to take part in a Delphi process that was aimed at assessing the events based on several characteristics. For instance, the experts assessed the event’s impact on mortality, the frequency of the event’s occurrence; the experts also defined the events. A total of 14 events were selected as the number was suitable for the provision of useful data. The events were then defined in detail, so as to avoid bias in data collection.
Impact of Medical errors on patient outcomes
It becomes a bit challenging when trying to compare adverse events and rates of medical errors across different studies. This is due to the differences in definitions and lack of a common definition stating what harm is. According to the study, there are two types of medical errors and adverse events. These include errors and adverse events related to procedures that take place in the ICU and those related to medication. The nursing staff is faced with challenge of ensuring that the right drugs are administered to the right patients, at the right time, and in the right dosage. Direct observation was used as a method of medical error detection. According to the results, an error was documented in every five doses administered doses. Omission constituted to over 23% of these errors. Mostly omitted drugs included preventive anticoagulants and ulcer protectors. Drugs that were mostly involved in medical errors included insulin, sedatives, catecholamine, coagulation-altering drugs, and vasopressors. Coagulation-altering drugs and Insulin are often used in ICUs, and the complexities involved in dosing makes them more prone to medical errors. A continuous increase in the usage of Insulin in ICUs was as a result of the emergence of evidence supporting insulin therapy among ICU patients in recent years.
Medical errors resulting from equipments and procedures carried out in the ICU were also investigated. Several incidents were reported in relation to mechanical ventilation. Other adverse events were associated with Pneumothorax, which is one of the main complications that results from catheter insertion and barotrauma. This constituted up to 1.5% of patients in the ICU. There are also adverse events associated with lines, drains, and tubes that are used during care of ICU patients. The error occurs when these tubes are removed accidentally. According to the study, there were a total of 22 removal incidences, out of 1000 patient-days in one of the study centers. There are also risks of increase in mortality rates as a result of poor maintenance given to homeostasis and acquired electrolyte disorders. Studies show that risk factors associated with medical errors and adverse events relate to the patient or to the ICU. The ICU entails the usage of highly sophisticated diagnostic tools and technologies meant for treatment purposes. The high sophisticated nature of these treatment processes relate to the increase in medical errors and adverse events in the ICU. The patient’s severity of illness also contributes to the increase in risks of medical errors or adverse events. For instance, one of the patients in the study had experienced two organ failures. This was treated as an independent risk factor for the adverse events.
Strategy for improvement
In order for the healthcare industry to win back the trust of the public, it requires to improve the quality of service delivery, and ensure that safety is their main priority. Currently, healthcare in the United States lags behind other high-risk industries in ensuring that public safety is maintained. This is basically due to the lack of a department or designated agency in the government, whose main agenda is monitoring and improving throughout the healthcare industry. the congress, therefore, has a responsibility of coming up with a Center for Patient Safety, whose main objective will be ensuring the safety of the public, by setting safety goals and tracking the progress towards the achievement of the goals. The center should be adequately funded in order to ensure smooth running of operations that will be aimed in making sure that all medical errors are eliminated. The Center for Patient Safety could be established inside the Agency for Healthcare Research and Quality (AHQR), since it already has the infrastructure and systems in place aimed at ensuring patient safety. The center would also be responsible for creating awareness and educating both the public and health practitioners about safety.
The United States government also chose to establish a public mandatory reporting system. The system would be used to collect any information about adverse medical events that may have resulted in serious harm or even death. The hospitals would then be required by law to report on such issues first, and eventually, al organizations in the healthcare department would be required to make reports. This kind of system will be instrumental in ensuring that serious cases of injury or adverse medical events are responded to, as the healthcare organizations and providers will be held accountable. Hospitals and other healthcare organizations should also be issued with incentives to establish internal safety systems, which will help in reducing the likelihood of medical errors occurring. The internal systems will also be responsible for informing the public on matters concerning patient safety. The government can also put voluntary reporting systems in place. These systems will act as a complement to the mandatory reporting systems already in place. The voluntary systems can accommodate much broader issues relating to medical errors. For instance, these systems can be used for errors that cause minimal or no harm. Voluntary systems can also help identify weaknesses in the healthcare systems and help fix errors before they can cause harm or even, prevent errors from happen. This kind of information can help healthcare organizations in their efforts of improving healthcare quality. In order to encourage voluntary reporting, the government should put laws in place to protect the confidentiality of all the collected information. Failure to enact such laws might discourage people from participating in the voluntary reporting, in fear of getting subpoenaed.
The government should also establish performance standards aimed at ensuring public safety. This can be achieved through the use of regulatory bodies, alongside other related mechanisms such as accreditation, licensing, and certification. These measures can be used to define the minimum performance levels for healthcare organizations, the professionals, and the tools used in healthcare delivery. With minimum performance level standards, the public will feel confident when accessing healthcare services in the country. Health professions should also lead by example by setting up norms and values that will influence the education and training processes of health providers. The professional societies should be leading the entire healthcare system by setting up their own performance standards and demanding that all players in the healthcare to comply. The societies can also help in improving patient safety by establishing training programs for its members and also, communicating with them about safety. Individual consumers and large purchasers can also influence healthcare organizations to make safety a priority. For example, a business buying health insurance covers for employees should include safety as a prime concern in decision making. This will force the healthcare institutions to deliver as specified, and ensure patient safety in the process.
A “culture of safety” would help organizations in healthcare to ensure that both the workforce and all the processes are focused towards improving the safety of patients under care. Organizations should include safety in their main goals. The quality of safety in healthcare organizations should be used to judge good leadership traits. Being the best should entail having safety incorporated in every aspect of the organization, such as designing jobs, working conditions, simplifying and standardizing processes and equipments, among other areas. Systems should also be put in place so as to monitor the quality control measures applied by the organization. This will help identify if the measures have any effect in improving the quality of service delivered and the improvement of patient safety. Hospitals and care givers should implement the available systems and technologies to improve efficiency and eliminate errors in medicine. The public also can play a major role in ensuring safety is maintained. For example, patients can learn about their medications by say, their appearance or side effects, and also, notify their doctors in case the side effects occur.
Conclusion
There are a high number of people who lose their lives annually in the United States as a result of medical errors. There are several types of errors; however, the most rampant one involves medication. Efficient reporting systems are required for these errors to be identified. The reporting systems are based on a combination of various methods. In order for the errors to be eliminated healthcare organizations and workers should be willing and able to accept and implement change. The health institutions should be willing to implement new standards and strategies. The workers also, should be able to change their work behaviors. All these efforts should be aimed at high quality service and ensuring safety.
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