October 9, 1997

Number of Medical Injuries Could Be As High as Three Million Nationally – Redesign of Health Care Systems May Provide the Solution

NEW YORK – The number of injuries caused by medical accidents in inpatient hospital settings nationwide could be as high as three million and cost as much as $200 billion, according to Lucian Leape, M.D., of the Harvard School of Public Health. Dr. Leape highlighted research conducted in the area of medical injury and discussed error prevention at a media briefing today entitled "Finding Cures for Medical Error" hosted by the National Patient Safety Foundation (NPSF) at the AMA.

The figures Dr. Leape cited are from a study conducted this year by researchers at the University of Chicago. The researchers, who used an on-site, real time observational method of collecting data, found that serious injuries due to errors occur in over 17 percent of patients admitted to intensive care and surgical units at a teaching hospital.

"When this figure is extrapolated to the hospital and then the nation as a whole, the incidence of injury can reach into the millions with costs climbing into the billions," said Dr. Leape. He then explained that past studies, like the Medical Practice Study conducted in 1991, used only information available in medical records and thus probably underestimated the extent and costs of accidental injury.

One reason that more has not been done to address the issue of medical error is that the health care system has not made safety a high priority.

"Because medical care is complicated, doctors, nurses, administrators and others have accepted errors and injuries as a necessary accompaniment of caring and curing. Hospitals have not thought of themselves as "high reliability" organizations, such as airlines or nuclear power plants, " explained Dr. Leape.

He added that health care is locked into a ineffective paradigm for preventing errors in that it relies entirely on training and standards, which are enforced by punishment for lapses. This punitive approach to errors provides a strong incentive for health care workers not to report their mistakes or those of colleagues. Concealing these errors robs clinicians and others from investigating the underlying causes and making the necessary changes to prevent recurrence.

According to Dr. Leape, creating a non-punitive environment is the first step in becoming a "high reliability" organization. A second step is to focus on system design.

Most errors result from faulty systems - -poorly designed processes that 'set people up' to make mistakes by putting them in situations where errors are more likely to be made," said Dr. Leape.

He concluded by discussing the rapid and positive steps that the health care community is taking to address the issue, such as the Institute for Healthcare Improvement's (IHI's) recent collaborative effort with 41 hospitals to redesign part of their medication system to reduce errors and the creation of the NPSF. The IHI is a Boston-based not-for-profit organization dedicated to improving the quality of health care. Dr. Leape chairs its medication error initiative.

"The formation of the National Patient Safety Foundation has given this movement increased visibility and stimulation. They next few years should witness fundamental changes in the way hospitals and health systems think about errors and about themselves," said Leape.

Launched this year, the NPSF is an unprecedented initiative to improve health care safety by studying why accidents in the health care system occur and implementing safeguards to prevent such failures from injuring patients. NPSF Board members represent every major segment of the health care system, as well as employers, medical ethicists, public health advocates and distinguished scientific research institutions.

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