I recently posted an article from the Channel Four website,
which was a transcript of their special feature on the NHS which received a lot
of publicity.
The Daily Mail and the rest of the conservative anti-NHS pack
leapt on the figures – from respected heavy weight researcher Professor Brian
Jarman with the headline; “Deaths in NHS Hospitals 45 % higher than in the U.S.”
There are so many variables that such a comparison is a waste
of time. Even worse, the reporters chose ‘The Mayo Clinic’ to compare its
outcomes unfavourably with our NHS.
The Mayo is where the rich go when they get ill. Pay a trip
to Kentucky or downtown Detroit and take a look at outcomes there. The problem
is that to compare the US with the UK is not to compare like with like.
In the U.S. if you don’t have insurance you don’t get
treated. As a result many avoid expensive treatment, with all the tragedies
that produces. The thing is, those terrible outcomes don’t show up on the
hospitals figures – those people aren’t admitted until it’s too late to do
anything for them.
Here everyone is treated, free of charge.
The Mayo doesn’t treat the poor for free.
This article from ProPublica, gives a different view on
outcomes from private healthcare in the U.S.;
How Many
Die From Medical Mistakes in U.S. Hospitals?
An updated
estimate says at least 210,000 patients die from medical mistakes in U.S.
hospitals a year.
by Marshall
Allen
ProPublica,
Sep. 19, 2013
It seems
that every time researchers estimate how often a medical mistake contributes to
a hospital patient’s death, the numbers come out worse.
In 1999,
the Institute of Medicine published the famous “To Err Is Human” report, which
dropped a bombshell on the medical community by reporting that up to 98,000
people a year die because of mistakes in hospitals. The number was initially
disputed, but is now widely accepted by doctors and hospital officials — and
quoted ubiquitously in the media.
In 2010,
the Office of Inspector General for Health and Human Services said that bad
hospital care contributed to the deaths of 180,000 patients in Medicare alone
in a given year.
Now comes a
study in the current issue of the Journal of Patient Safety that says the
numbers may be much higher — between 210,000 and 440,000 patients each year who
go to the hospital for care suffer some type of preventable harm that
contributes to their death, the study says.
That would
make medical errors the third-leading cause of death in America, behind heart
disease, which is the first, and cancer, which is second.
The new
estimates were developed by John T. James, a toxicologist at NASA’s space
center in Houston who runs an advocacy organization called Patient Safety
America. James has also written a book about the death of his 19-year-old son
after what James maintains was negligent hospital care.
Asked about
the higher estimates, a spokesman for the American Hospital Association said
the group has more confidence in the IOM’s estimate of 98,000 deaths.
ProPublica asked three prominent patient safety researchers to review James’
study, however, and all said his methods and findings were credible.
What’s the
right number? Nobody knows for sure. There’s never been an actual count of how
many patients experience preventable harm. So we’re left with approximations,
which are imperfect in part because of inaccuracies in medical records and the
reluctance of some providers to report mistakes.
Patient
safety experts say measuring the problem is nonetheless important because
estimates bring awareness and research dollars to a major public health problem
that persists despite decades of improvement efforts.
“We need to
get a sense of the magnitude of this,” James said in an interview.
James based
his estimates on the findings of four recent studies that identified
preventable harm suffered by patients – known as “adverse events” in the
medical vernacular – using use a screening method called the Global Trigger
Tool, which guides reviewers through medical records, searching for signs of
infection, injury or error. Medical records flagged during the initial
screening are reviewed by a doctor, who determines the extent of the harm.
In the four
studies, which examined records of more than 4,200 patients hospitalized
between 2002 and 2008, researchers found serious adverse events in as many as
21 percent of cases reviewed and rates of lethal adverse events as high as 1.4
percent of cases.
By
combining the findings and extrapolating across 34 million hospitalizations in
2007, James concluded that preventable errors contribute to the deaths of
210,000 hospital patients annually.
That is the
baseline. The actual number more than doubles, James reasoned, because the
trigger tool doesn’t catch errors in which treatment should have been provided
but wasn’t, because it’s known that medical records are missing some evidence
of harm, and because diagnostic errors aren’t captured.
An estimate
of 440,000 deaths from care in hospitals “is roughly one-sixth of all deaths
that occur in the United States each year,” James wrote in his study. He also
cited other research that’s shown hospital reporting systems and peer-review
capture only a fraction of patient harm or negligent care.
“Perhaps it
is time for a national patient bill of rights for hospitalized patients,” James
wrote. “All evidence points to the need for much more patient involvement in
identifying harmful events and participating in rigorous follow-up
investigations to identify root causes.”
Dr. Lucian
Leape, a Harvard pediatrician who is referred to the “father of patient
safety,” was on the committee that wrote the “To Err Is Human” report. He told
ProPublica that he has confidence in the four studies and the estimate by
James.
Members of
the Institute of Medicine committee knew at the time that their estimate of
medical errors was low, he said. “It was based on a rather crude method
compared to what we do now,” Leape said. Plus, medicine has become much more
complex in recent decades, which leads to more mistakes, he said.
Dr. David
Classen, one of the leading developers of the Global Trigger Tool, said the
James study is a sound use of the tool and a “great contribution.” He said it’s
important to update the numbers from the “To Err Is Human” report because in
addition to the obvious suffering, preventable harm leads to enormous financial
costs.
Dr. Marty
Makary, a surgeon at The Johns Hopkins Hospital whose book “Unaccountable”
calls for greater transparency in health care, said the James estimate shows
that eliminating medical errors must become a national priority. He said it’s
also important to increase the awareness of the potential of unintended
consequences when doctors perform procedure and tests. The risk of harm needs
to be factored into conversations with patients, he said.
Leape,
Classen and Makary all said it’s time to stop citing the 98,000 number.
Still,
hospital association spokesman Akin Demehin said the group is sticking with the
Institute of Medicine’s estimate. Demehin said the IOM figure is based on a
larger sampling of medical charts and that there’s no consensus the Global
Trigger Tool can be used to make a nationwide estimate. He said the tool is
better suited for use in individual hospitals.
The AHA is
not attempting to come up with its own estimate, Demehin said.
Dr. David
Mayer, the vice president of quality and safety at Maryland-based MedStar
Health, said people can make arguments about how many patient deaths are
hastened by poor hospital care, but that’s not really the point. All the
estimates, even on the low end, expose a crisis, he said.
“Way too
many people are being harmed by unintentional medical error,” Mayer said, “and
it needs to be corrected.”
Neil Harris
(a don’t stop till you drop production)
Home:
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