Is medical error the third leading cause of death in the US?

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Hot off the press from the British Medical Journal, researchers have calculated that medical error kills 251,000 Americans a year. This ranks thirds behind heart disease and cancer, and ahead of COPD, suicide, motor vehicle accidents and firearms.

As they explain, “Medical error has been defined 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….Human error is inevitable. Although we cannot eliminate human error, we can better measure the problem to design safer systems mitigating 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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UPDATE: June 2016

In a response, other researchers criticized the methodology, numbers and focus on death as the only outcome of medical error. As they explain, “In all three studies, reviewers estimated that around 3% to 5% of deaths were ‘probably preventable’ (a greater than 50% chance that optimal care would have prevented death). The largest and most recent of these studies[5] reported that trained medical reviewers judged 3.6% of deaths to have at least a 50% probability of avoidability. Applying this rate of preventability to the total number of hospital deaths in the US each year produces an estimate of about 25,200 deaths annually that are potentially avoidable among hospitalized patients in the US—roughly 10-fold lower than the estimate advanced by Makary and Daniel…

A further problem with the estimate is more subtle. Making the field of patient safety all about death has risks. Just as most deaths do not involve medical error, most medical errors do not produce death—but they can still produce substantial morbidity, costs, suffering and distress. Drawing attention only to death as the focus of patient safety efforts risks drawing resources away from many settings of care – including almost all non-hospital environments – where death is not the most relevant outcome.

As people who care deeply about patient safety, we are troubled by at figures that produce lurid headlines but distract from areas where harm may be most amenable to interventions. As researchers, we fear for efforts to engage with clinicians when they are confronted by headline-grabbing numbers that fly in the face of their clinical experience. And, finally, as concerned citizens, we would rather not have medical care characterized as more dangerous than firearms or motor vehicles.”

 

As the debate on the scale of medical error continues, this website aims to contribute to the broader conversation: raising error awareness, fostering a culture of safety, and improving clinical skills and judgment to make errors less frequent

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