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Recent Medical Errors Reported by 45% of Specialists
37% Caused Serious
Harm, Errors Probably Under-Reported
Aug. 3, 2004 -
Otolaryngologist Dr. David Roberson has first-hand experience with
medical errors. He remembers one near-miss in a patient about to
receive a cochlear implant and says it typifies the kinds of
mistakes he and his colleagues have turned up in a national survey.
"I looked at the CT scan
carefully to determine if the cochlea would accept the implant,"
recalls Roberson, from the Department of Otolaryngology and
Communication Disorders at Children's Hospital Boston. "I asked a
colleague to look at it also, and he commented that the auditory
nerves looked small. I then ordered an MRI which showed the patient
had no auditory nerves on either side. I came close to performing
surgery and putting a major device in a child's head when there was
no possibility of benefit, since she had no auditory nerve. I didn't
look carefully enough at the entire scan."
Roberson and colleagues
sent a brief, anonymous survey to 2,500 members of the American
Academy of Otolaryngology-Head and Neck Surgery, and received 466
responses (19 percent). Of these, 210 physicians -- 45 percent --
reported that a medical error had occurred in their practice in the
past six months. Errors occurred in all phases of patient care; 78
(37 percent) caused major injury or harm, and 9 (4 percent) were
fatal. Both adults and children were affected.
Errors were carefully
classified. The largest category, accounting for 19 percent, was
technical errors during procedures, and 56 percent of these caused
major injury or harm. Next were medication errors (14 percent);
these included dosage mistakes and giving medications to which the
patient was allergic, or that were contraindicated. Testing errors
(10 percent) included physician errors (ordering incorrect tests;
not reviewing tests; not acting on the results) and lab errors (lost
specimens; errors in labeling and interpretation of results).
Surgical planning errors (scheduling mistakes; failing to ensure
that all preoperative studies were complete; and judgment errors,
such as undertaking surgery when it was risky) accounted for another
10 percent.
Younger physicians were
more likely than physicians over age 50 to report errors
(approximately 60 versus 40 percent).
Other errors included:
Equipment errors
equipment not available or improperly assembled; equipment failure
(9.4 percent)
Errors in post-operative
care (8.5 percent)
Wrong site surgery
wrong patient, wrong organ, or wrong side (6 percent);
Drug errors during
surgery (4 percent)
Communication errors (4
percent)
Roberson and colleagues
believe that the proportion of physicians encountering an error --
45 percent - is an underestimate. They suggest that doctors may not
be trained to recognize errors, and may tend to recall errors that
have serious consequences but overlook minor ones.
In one of two editorials
accompanying the study, Dr. Lucian Leape of the Harvard School of
Public Health concurs, "In the absence of a significant adverse
event, most clinicians do not recognize (or admit) errors."
Leape adds that the study
provides a unique and useful classification scheme for medical
errors. "Not only does this scheme make clinical sense, it would
seem to have applicability to other surgical specialties," he
writes.
The study is the cover
article in the August issue of the journal Laryngoscope. "The
probability of an otolaryngologist erring on any individual decision
is miniscule," the authors note. "However, because we all make
millions of medical decisions, we will all make many errors during
our careers
Most errors are made by good or outstanding providers."
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Children's Hospital
Boston is the nation's leading pediatric medical center, the largest
provider of health care to Massachusetts children, and the primary
pediatric teaching hospital of Harvard Medical School. Children's
provides pediatric and adolescent health services for patients from
birth through age 21. In addition to 325 inpatient beds and
comprehensive outpatient programs, it houses the world's largest
research enterprise based at a pediatric medical center. More than
500 scientists, including eight members of the National Academy of
Sciences, nine members of the Institute of Medicine and 10 members
of the Howard Hughes Medical Institute comprise Children's research
community. For more information visit:
www.childrenshospital.org.
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