June 18, 2008

“The chances that we will kill you are higher in hospitals than in doctors’ offices,” notes Robert M. Wachter, MD, professor and associate chairman of the department of medicine at the University of California, San Francisco, and author of Understanding Patient Safety. You’re particularly vulnerable in the emergency room (ER) and intensive care unit (ICU), where odds are you’re already seriously ill and require multiple procedures from time-stressed providers, explains Janet Corrigan, PhD, of the National Quality Forum in Washington, D.C. “You’re also at risk on the hospital’s pediatric floors because of the challenges of caring for children.”

In some ways, this is nothing new. “Hospitals have always been dangerous places,” says Kaveh G. Shojania, MD, associate professor at the University of Toronto. But there’s now a perfect storm of factors that is putting too many patients at risk.

Hospital-acquired infections are on the rise
The rise of antibiotic-resistant bacteria like methicillin-resistant Staphylococcus aureus (MRSA) has transformed hospital-acquired infections from manageable risks to major killers, says Martin J. Hatlie, JD, president and founder of the Chicago-based nonprofit Partnership for Patient Safety. Hospital-acquired infections (HAIs) affect more than 1.7 million patients, killing more than 99,000 of them a year—and many of these deaths are not reflected in the official “hospital errors” death count.

Nurses are spread too thin
High turnover and vacancy rates in nursing mean you’re more likely than ever to have an overstretched nurse at the other end of that call button, according to an April 2008 statement from the American Association of Colleges of Nursing. “We know people are more likely to make mistakes when they’re multitasking, distracted, and tired,” Hatlie says. “Nurses today are always in that situation.”

Residents are working shorter shifts
Regulations now limit the number of hours residents can work, to 30 hours straight (compared with the 48 in a row many logged before 2003). Sending sleep-deprived young doctors home to get some rest sounds like a smart strategy, but it has created an unexpected problem: It increases the number of handoffs, which contributes to additional mess-ups. “The single highest risk time is when there’s a transition in care because so many little pieces of information can get lost in translation,” Dr. Shojania says.

One study found that patients were five times as likely to have an “adverse event”—any injury caused by medical care—when covered by a doctor who didn’t know them, which happens when a shift changes, explains David Bates, MD, chief of the division of general internal medicine at Brigham and Women’s Hospital in Boston.

Modern medicine is saving more people
“We’re giving life where we couldn’t five years ago,” Hatlie says. The problem: “Every new procedure brings a new risk.” Patients today are more likely to be “really sick people,” he says. “When you’re sicker, you’re weaker and less likely to survive an error.”
Next: What Can Go Wrong
Back to "Your Guide to Preventing Medical Mistakes" Intro
By Lorie A. Parch
Additional reporting by Kimberly Holland and Brittani Tingle

Related Links:
How to Avoid Becoming a Medical Mistake
Skills to Use in the Hospital
Five Surgeries to Avoid

You May Like