Study: Medical Error Deaths 4.5 Times More Likely Than IOM Estimate

The number of U.S. hospital patients who die from medical errors each year could be up to 4.5 times higher than the Institute of Medicine estimated in its landmark 1999 report, "To Err is Human," according to a study in the Journal of Patient Safety.

In 1999, the IOM published "To Err is Human: Building a Safer Health System," which estimated that up to 98,000 patient deaths occur in the U.S. per year due to medical errors. This estimate is based on 1984 data from physician reviews of New York hospital patient medical records. Author John T. James, PhD, chief toxicologist for the National Aeronautics & Space Administration and founder of advocacy group Patient Safety America, aimed to update this estimate by conducting a review of studies published from 2008 to 2011.

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He identified four studies that examined adverse event incidence using the Global Trigger Tool, in which medical records are reviewed for certain triggers that suggest an adverse event has occurred. These studies included two Office of Inspector General studies, one in 2008 and one in 2010, a 2011 Health Affairs study and a 2010 New England Journal of Medicine study.

A weighted average of these studies revealed that at least 210,000 deaths were associated with preventable adverse events in hospitals each year. However, the GTT does not identify diagnostic errors or errors of omission, including failure to follow guidelines, and medical records often do not include all adverse events, according to the study. When accounting for these missed errors, the estimated number of deaths linked to preventable adverse events balloons to 440,000 — about 4.5 times the IOM estimate and approximately one-sixth of all annual U.S. deaths.

Dr. James suggested several possible reasons for the increased estimate compared with the IOM's figure, including different criteria for identifying a preventable adverse event among the studies, the potentially superior ability of the GTT to identify adverse events and an increase in the rate of adverse events over time. He concluded, "In a sense, it does not matter whether the deaths of 100,000, 200,000 or 400,000 Americans each year are associated with [preventable adverse events] in hospitals. Any of the estimates demands assertive action on the part of providers, legislators and people who will one day become patients." He wrote that he hopes the current study will spur faster improvement in patient safety.

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