Pop Quiz: How many people are US hospitals killing?

Posted by Sten Westgard, MS

It's almost mandatory that any presentation or report discussing patient safety references the landmark IOM report of 2000: To Err is Human - Building a Safer Health System. The takeaway quote from this report is that US hospitals were causing 44,000 to 98,000 deaths that were otherwise preventable. That is, hospitals were causing tens of thousands of avoidable deaths.

A recent paper has attempted to revise that estimate, focusing on Preventable Adverse Events (PAEs) that contributed to the death of patients. Can you guess how lethal US hospitals are now?

1. 4,000 to 10,000 PAEs per year
2. 44,000 to 98,0000 PAEs per year
3. 100,000 to 200,000 PAEs per year
4. 210,000 to 440,000 PAEs per year

The answer, after the jump...

According to a new study, US hospitals are much worse than previously thought. The study estimates between 210,000 to 440,000 PAEs each year. This means our patient safety problem is 10 to 20 times worse than we thought.

John T. James, A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care,J Pat Safety 2013;9(3):122-128. (Subscription required)

Dr. James is from Patient Safety America and reviewed the 4 most salient studies on adverse events, then incorporated several additional factors, including the fact that many adverse events go unreported or unrecognized until autopsy.

Given that the PAE estimate is based on a 2007 estimate of 34.4 million hospitalizations, even the "conservative" figure of 210,000 PAEs means that the error rate is about 0.6% - or just below a 4 Sigma process. The more frightening estimate of 440,000 gives an error rate of about 1.27% - or about a 3.8 Sigma process.

The study concludes:

"In a sense, it does not matter whether the deaths of 100,000, 200,000 or 400,000 Americans each year are associated with PAEs in hospitals. Any of these estimates demands assertive action on the part of providers, legislators,, and people who will one day become patients."

All of these numbers are rather shocking, and given the emphasis the ACA is placing on linking reimbursement to better care, hospitals need to double their efforts to reduce these deaths.