Surgical Errors
Errors in surgery have the highest risk of severe patient injury and death. Intraoperative errors are estimated to be the primary issue in 75% of malpractice cases involving surgeons. Surgical errors involving the wrong site, patient, or procedure should never occur. Investigations into the factors that led to these types of surgical errors have demonstrated that common causes include clinician factors (eg, feeling rushed, distractions, and fatigue), miscommunication, changing or inadequate staffing, organizational factors (eg, discarding specimens as waste and not labeling specimens), medical record issues, and cognitive errors.
Diagnostic Errors
The National Academy of Medicine defines a diagnostic error as “the failure to establish an accurate and timely explanation of a patient’s health problems or to communicate that explanation to the patient,” therefore, delayed or missed diagnoses are considered errors as well. According to the Joint Commission, diagnostic errors result in the death or injury of 40,000 to 80,000 patients annually. Diagnostic errors are most common in primary care solo practices due to workload, time constraints, and the inability to confer easily with colleagues. One study estimated that 12 million patients in the US had a diagnostic error made during their care, with 33% of those errors resulting in patient injury. Conversely, patients seen in teaching medical institutions have many clinicians (eg, attendings, residents, fellows, and medical students), decreasing the chance of diagnostic error. Diagnostic errors cause adverse events for approximately 5% of outpatients and 17% of hospitalized patients.
Medication Errors
Because there are several components involved with patient medications (eg, prescribing, dispensing, dosing, and administering), errors can occur in any of those areas. However, many medication errors are considered preventable. Common medication errors include overriding medication-use safeguards, mistakenly administering a similar-sounding medication, or using out-of-date medications. System changes that can help decrease medication errors include computerized provider order entry (CPOE), barcoding systems to identify patients and medications, standardized units of measure, weight-based dosing, and having a pharmacist available to assist with calculating the correct dose. Furthermore, rechecking medication names and dosing before administration is critical to avoid preventable medication errors.
Device and Equipment Errors
Health professionals generally believe technology will improve healthcare efficiency, lower cost, increase quality, and promote safety; however, these same technologies may also introduce errors and adverse events. Millions of healthcare providers use approximately 5000 types of medical devices worldwide, so device-related errors are inevitable. Medical equipment design flaws, mishandling, user error, and malfunction are common causes of medical errors. Additionally, a significant number of medical devices have been implanted in patients (eg, pacemakers, defibrillators, and nerve and brain stimulators), which may malfunction and result in life-threatening complications. Equipment errors can be due to device differences between manufacturers, inadequate testing and maintenance, poor design, and poor maintenance. Errors involving tube and catheter connections (eg, using catheters for unintended purposes, running the wrong line through a pump, and misplacing feeding tubes into the lung) are also common. These adverse events can have life-threatening effects if a misconnection is not corrected early. To complicate the situation further, medications and food supplements are often delivered via these routes, and placement errors can result in administration or omission mistakes.
Hospital-Acquired Infection
Healthcare-related infections are considered a failure of the system. As many as 1 in 20 hospitalized patients may acquire a healthcare-related infection, increasing complications and the length and cost of the hospital stay. Healthcare-related infections add close to $35 billion to the annual cost of healthcare in the United States. Common causes of hospital-acquired infections include failure to practice basic hand hygiene and poor technique in placing indwelling urinary and vascular catheters. Subsequently, the most prevalent infections are catheter-associated urinary tract infections, surgical site infections, hospital-acquired pneumonia, central line-associated sepsis, and care-related skin and soft tissue infections.
Falls
Each year, over one-third of people older than 65 suffer a fall, with one-third of these causing injury. Instituting fall prevention protocols in hospitals and long-term care facilities has significantly reduced these errors. Studies have shown that fall risk assessments using standardized scales such as the Morse fall scale can decrease patient falls. Institutional interventions such as staff education, patient mobility training with rehabilitation professionals, and nutritionist support have also been shown to reduce patient falls. Other strategies include identifying patients at high risk for falls, providing patient safety companions, educating caregivers about fall prevention, and setting bed alarms and frequent safety rounds for all high-risk patients.
Communication
Optimal interprofessional communication, as well as with patients, is essential for patient care. Therefore, communication errors commonly result in adverse events. Reasons for impaired communication include disruptive patient behavior, environmental distractions (eg, cell phones and pagers), cultural differences, hierarchy issues, personality differences, language barriers, and socioeconomic variables, such as education and literacy.
If you or a loved one may have been harmed as a result of a medical error in the United States, you should promptly find a medical malpractice lawyer in your state who may investigate your medical malpractice claim for you and represent you or your loved one in a medical malpractice case, if appropriate.
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