Tessa Quinn
The number of avoidable deaths in hospitals is a pressing issue, with studies estimating that between 22,000 and 250,000 patients in the United States die annually due to preventable causes. This wide range is due to differences in study methodologies and biases, with some studies suggesting that previous estimates were too high. While the majority of hospital deaths are due to underlying diseases, medical errors, such as incorrect diagnoses or delays in therapy, also contribute significantly to patient mortality. These errors can occur during prescribing medications, dispensing by pharmacists, or even due to unintentional non-adherence by patients. The COVID-19 pandemic further highlighted the disparities in healthcare access and monitoring, particularly in rural areas, which can lead to preventable premature deaths.
| Characteristics | Values |
|---|---|
| Number of preventable inpatient deaths in the USA | 44,000–98,000 deaths annually |
| Number of preventable inpatient deaths in the USA (new estimate) | 22,000 deaths annually |
| Number of previously healthy people who die every year from hospital error | 7,150 |
| Number of preventable deaths in New York hospitals | 1 in 4 negligent adverse events led to death |
| Number of preventable deaths in Colorado and Utah hospitals | 1 in 11 negligent adverse events led to death |
| Number of preventable deaths in Finnish secondary teaching hospitals | Uncommon |
| Percentage of preventable deaths out of 12,503 deaths | 3.1% |
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What You'll Learn
Medical errors are a leading cause of avoidable deaths
While the exact number of avoidable deaths in hospitals is difficult to pinpoint, various studies have attempted to shed light on this issue. A 1999 study by the Institute of Medicine estimated that between 44,000 and 98,000 Americans die each year due to medical errors, a figure that has been widely cited and even gave rise to the cliché "a jumbo jet crash every day." However, this estimate has been criticized as an overestimation, with more recent studies suggesting lower numbers.
A 2020 meta-analysis by researchers at Yale University found that about 22,000 preventable deaths occur annually in the United States, with most of these deaths occurring in patients with less than a three-month life expectancy. This study included only studies conducted after 2007 that took a more direct approach by starting with hospital deaths and working backward to determine their cause and preventability. The majority of these hospital errors involved poor monitoring or management of medical conditions, diagnostic errors, and errors related to surgery and procedures.
Despite the lower estimate, medical errors remain a critical issue in healthcare. Studies have shown that adverse events resulting from medical errors can cost the healthcare system billions of dollars annually. Additionally, healthcare professionals may experience profound psychological effects, including anger, guilt, inadequacy, depression, and even suicidal ideation. The fear of punishment or legal consequences further complicates the issue, as it may lead to underreporting of medical errors, hindering efforts to improve patient safety.
To address this challenge, healthcare institutions must focus on quality improvement and a culture of learning from mistakes rather than solely on individual punishment. By encouraging the reporting of medical errors and conducting thorough root cause analyses, institutions can identify institutional deficiencies and implement corrective measures to prevent similar errors in the future. Additionally, healthcare professionals should familiarize themselves with different types of medical errors to better understand the adverse events that may occur and develop appropriate preventive strategies.
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Preventable deaths due to problems in care
The number of preventable inpatient deaths in the USA is commonly estimated to be between 44,000 and 98,000 per year. However, a 2020 meta-analysis of eight studies published in the Journal of General Internal Medicine found that the number of preventable deaths was closer to 22,000 per year, a significant decrease from previous estimates. This meta-analysis included only studies conducted after 2007 that took a more direct approach by starting with hospital deaths and working backward to determine their cause and preventability.
The incidence of preventable hospital deaths is much lower than previously estimated, but the burden of harm from preventable problems in care remains substantial. Most hospital errors leading to preventable deaths involve poor monitoring or management of medical conditions, diagnostic errors, and errors related to surgery, procedures, drugs, or fluids. These issues were more prevalent among surgical patients than medical patients, and they were largely related to ward care rather than technical care.
In England, estimates of preventable hospital deaths range from 840 to 40,000 per year, with a retrospective case record review of 1,000 adults who died in 2009 in 10 acute hospitals in England finding that 5.2% of deaths had a 50% or greater chance of being preventable. This study identified poor clinical monitoring, diagnostic errors, and inadequate care as the principal problems associated with preventable deaths.
While the number of preventable deaths in hospitals may be lower than previously thought, it is still essential to address these issues to improve patient safety and reduce harm. Monitoring hospital mortality rates and identifying areas for improvement can help reduce the incidence of preventable deaths and improve the quality of care.
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Clinical monitoring and management issues
One of the critical aspects of clinical monitoring is the timely and appropriate response to monitoring systems. This includes acting upon the results of tests or clinical findings and adjusting the intensity of care when necessary. For example, in cases where a patient's condition worsens, an increase in the frequency of vital sign checks or the implementation of additional monitoring devices may be warranted. Failure to recognise and respond to these warning signs can lead to adverse outcomes, including death.
Another factor is the establishment of monitoring systems themselves. This involves the initial setup and configuration of monitoring equipment, such as cardiac monitors, pulse oximeters, or specialised devices tailored to specific patient needs. Ensuring that these systems are properly calibrated and functioning correctly, and providing accurate data is essential for effective clinical monitoring.
In addition to technical considerations, clinical monitoring encompasses the interpretation of data and subsequent decision-making. Clinical staff must possess the knowledge and expertise to recognise abnormal findings and initiate appropriate interventions. This includes understanding the significance of specific trends or changes in vital signs and having the ability to identify emerging complications or conditions that may not have been present during the patient's admission.
Furthermore, effective clinical monitoring requires clear and consistent communication among healthcare providers. This involves documenting and conveying relevant information accurately, ensuring continuity of care, and enabling prompt adjustments to the patient's care plan when required. Effective communication also extends to patients and their families, empowering them with the knowledge and instructions necessary for self-management and ongoing care.
Management issues, on the other hand, pertain to the overall supervision and coordination of patient care. This includes ensuring that patients receive the necessary treatments, interventions, and medications in a timely and appropriate manner. Management issues may arise from inadequate staffing levels, insufficient resources, or systemic failures within the healthcare organisation. These issues can lead to delays in diagnosis and treatment, incorrect or outdated treatment protocols, and other shortcomings that negatively impact patient outcomes.
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Diagnostic errors
While there are no exact figures on the percentage of avoidable deaths in hospitals, a range of estimates exists. A 1999 study by the Institute of Medicine estimated that there were 44,000 to 98,000 annual deaths from unsafe care in the United States. Other frequently cited studies have placed the number of deaths as high as 250,000 per year, which would make medical errors the third leading cause of death, behind cancer and cardiovascular disease.
However, a 2020 meta-analysis of eight studies by researchers at Yale University found evidence of about 22,000 preventable deaths annually, mostly in people with less than three months to live. This suggests that previous estimates of preventable hospital deaths may be too high.
The wide disparity in estimates can be attributed to differences in research methodologies. The 1999 Institute of Medicine study, for instance, began by looking at admitted patients with any adverse event, such as an incorrect diagnosis or delay in therapy, and then assessed the preventability and harm of those errors. On the other hand, the Yale researchers' meta-analysis included only studies conducted after 2007, adopting a different approach. They started with hospital deaths and worked backward to determine their cause and preventability.
Overall, while the exact percentage of avoidable deaths in hospitals due to diagnostic errors is unclear, diagnostic errors are recognised as a significant factor contributing to preventable deaths, highlighting the importance of accurate and timely diagnoses in patient care.
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Surgery and procedural complications
Among the causes of these preventable deaths are surgery and procedural complications. A systematic review of inpatient deaths found that 3.1% of 12,503 deaths were judged to be preventable, with surgery and procedural complications being one of the leading causes.
The annual volume of surgery is almost double that of obstetrical deliveries, and surgical death rates far surpass maternal mortality rates. Global estimates suggest that at least 7 million people suffer complications following surgery each year, including at least 1 million deaths. As many as 50% of these deaths and complications are preventable. Patients undergoing surgery face immediate dangers from the technical risks of the procedures themselves and the anesthesia required.
Strategies to improve surgical outcomes include the adoption and use of basic technologies, the development of monitoring standards, and the use of surgical safety checklists. For example, the World Health Organization (WHO) has developed a set of basic surgical standards in the form of a 19-item checklist to be used during the perioperative period. The use of this checklist nearly doubled adherence to basic perioperative safety standards and reduced deaths by more than 47% while cutting complication rates by 35%.
Additionally, higher-volume hospitals have demonstrated a better ability to recognize, intervene, and save patients undergoing high-risk procedures. The quality of communication, the systems of care, and the skills and capacity of ancillary services are important factors in improving outcomes following surgical complications.
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Frequently asked questions
It is estimated that between 3.1% and 58% of inpatient deaths are avoidable. Previous estimates of 44,000-98,000 avoidable deaths per year may be two to four times too high.
The most common causes of avoidable deaths include clinical monitoring and management issues, diagnostic errors, surgery/procedural complications, drug- or fluid-related complications, and errors related to infections or antibiotic choice.
It is estimated that about 7,150 previously healthy people die every year from hospital error.
Yes, there are regional differences in the number of avoidable hospital deaths. For example, in New York, about one in four negligent adverse events led to death, while in Colorado and Utah, it was about one out of every 11 negligent adverse events.
