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Reflections on Safety is a monthly column presenting the insights of Tejal K. Gandhi, MD, MPH, CPPS, Chief Clinical and Safety Officer, Institute for Healthcare Improvement (IHI). Dr. Gandhi was president and CEO of the National Patient Safety Foundation prior to its merger with IHI in May 2017.


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On More Evidence of the Toll of Medical Errors

Posted By Administration, Tuesday, May 10, 2016
Getting an accurate picture of the problem could help increase research funding for solutions.

By Tejal K. Gandhi, MD, MPH, CPPS

Tejal K. Gandhi


The patient safety community—and much of the medical field in general—took notice last week at publication of a new study estimating the toll of medical errors. Comparing data from a number of earlier studies, the authors calculated that more than 250,000 deaths per year stem from medical errors, making this category the third leading cause of death, behind heart disease and cancer.

Speaking for the National Patient Safety Foundation, I can say I am not shocked by the numbers suggested by this analysis. Although there have been some criticisms of the new paper’s methodology—mainly that the comparative studies were done on small sample sizes and are just being extrapolated to identify the national numbers—I applaud the authors for increasing public attention on an issue with which health professionals, as well as many patients and families, are all too familiar.

One of the authors’ main arguments is that medical error is not being adequately measured because it is not considered a cause of death on death certificates. They suggest, “…death certificates could contain an extra field asking whether a preventable complication stemming from the patient’s medical care contributed to the death.” If there were an ICD code for medical error, the authors propose, the CDC would be able to track deaths from that cause the way they track mortality from other causes.

While it is absolutely true that medical error is not currently adequately measured, adding “medical error” to death certificates is not as simple as it sounds; often the person completing the death certificate may not know if the death was preventable. Even when error is suspected, it often takes time to investigate and identify underlying causes.

In discussing the new study, Dr. Martin Makary, the lead author, pointed out that the numbers reported by the CDC are important because they help set the national research agenda. This is why NPSF, in our recent report Free From Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err Is Human, called for federal agencies to create a portfolio of national standard patient safety process and outcome metrics across the care continuum and to retire invalid measures that are not useful or meaningful.

Better measures nationally for all medical errors will help to truly capture the extent of harm. Better measurement will also help identify research needs and increase leadership prioritization of these issues. It is time for us to begin addressing medical errors as we do other serious public health crises—with robust measurement, scientific analysis, and collaborative approaches to solutions that can reduce the toll on patient, families, and the health care workforce.

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Tejal K. Gandhi, MD, MPH, CPPS, is president and chief executive officer of the National Patient Safety Foundation and of the NPSF Lucian Leape Institute.

Tags:  measurement  public health 

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