Is reducing medical errors similar to improving transportation safety?

According to a recent op-ed, Jim Hall, former chairman of the National Transportation Safety Board, says, “Because American medicine accepts error as an inevitable consequence of treatment, our hospitals, insurers and government do little to respond to unnecessary deaths. If we are to address the problem in a serious manner, we must first change this culture.”

But a simple solution to reduce medical errors may be elusive, says emergency physician Graham Walker. He comments that the human body is significantly more complex than the transportation industry, writing, “I feel like there’s many more that can go wrong with humans–not just the patient, but also the multiple humans taking care of the patient.”

He also points out the unintended consequences of striving for zero medical errors, such as some of Medicare’s “never” events, like the goal of zero thrombotic events after orthopedic procedures: “So the hypercoaguable patients just won’t get orthopedic procedures, because orthopods just won’t touch them anymore, for risk of triggering a ‘never event,’ which the hospital won’t pay for.”

Although there’s no question we need to do better to reduce medical errors, poorly thought-out initiatives can potentially make things worse. And indeed, I wrote previously that, when it comes to some Medicare never events, “Penalizing hospitals for events that cannot be prevented is counterproductive and leads to unintended consequences, including driving up the cost of care by exposing patients to more testing, thereby decreasing access to medical care.”

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  • pat

    It’s possible to eventually get to the point where no one dies in an airplane crash, but it is not possible to get to the point where no one dies of anything. Since analyzing every death, complication, or health event will inevitably lead to some retrospective guessing that things might have gone differently, the definition of error itself in medicine is seen through many beholders. There is a growing public perception that all health badness can be “prevented” or “caught in time”, and this is so far from the case that it defies our imagination as providers. The true problem with focusing on error is that it makes every bad outcome look like an error in the eyes of relatives and loved ones.

  • Supremacy Claus

    The never events are not medical errors, they are pretextual government oppression, intimidation, and attempt to weasel out of payments due.

    There are real medical errors, and they are like air crashes.

    First, they do not have a chain of causation, a Medieval superstition to which the courts still adhere. Like air crashes, a cluster of factors comes together at a single place and time. The average may be 12. Each is required for the disaster to take place.

    Second, the deletion or prevention of only one or two may prevent the entire disaster.

    Third, reduction of disasters may be achieved by a change in the system to address the 12 factors. In Demming, the unit could be closed until the factors are found, and the system is changed.

    This modern view of disaster makes all medical malpractice claims based on superstition, like saying, devils did it or a curse has been placed on the victim. Furthermore, the pursuit of single scapegoats precludes and delays prevention. The fear of institution ending litigation also causes a deep cover up.

    As a patient, I am willing to not sue if the administration will rush from home at midnight to get as many facts as possible after I am injured by a medical mistake. Change the system, and publish the results of the investigation to the web. Others may institute system changes without having to hurt a patient first. I know that any settlement comes from the care of other patients, and that no money will restore me. I also know that the coverup will insure that many others suffers the same injury from covered up medical errors.

  • http://www.futurewaredc.com Chuck Brooks

    This is why the phrase ‘practice of medicine’ is appropriate, and for the same reason as ‘practice of law’ is accurate in that field of activity. If either of these things were deterministic then there would be no need for doctors or lawyers, among other things.
    Chuck Brooks
    FutureWare SCG

  • Rezmed09

    How about limiting work hours for docs like the FAA does with pilots?

    As far as I can tell, pilots only fly one plane at a time, aren’t threatened with lawsuits while flying, aren’t talking to insurance companies while flying, and aren’t being told to fly a plane that should be grounded.

  • anon

    Compare medicine to aviation and transportation when this is considered routine:

    http://micom.net/oops/AirMaint.jpg

  • jenga

    Unintended consequences
    Don’t pay for catheter related infections, guess what hospitals ban indwelling foleys and if you are sick you get the priviledge of lying in your own piss. Our government at it’s finest.

  • Mike

    A medical mistake is if you amputate the wrong arm or leg, or if you remove the wrong breast, or if you administer the wrong drug or dose.

    A medical error is not a known complication of a procedure or hospitalization. Ventilator acquired pneumonia, sacral decubitus ulcers, Foley catheter infections, deep vein thromboses are not 100 percent preventable. So to NEVER PAY FOR THEM is offensive.

  • W

    If something does go wrong, at least in a large clinic setting, who decides how to respond — the medical staff directly involved, or the risk management attorneys (who weren’t there, have limited if any medical knowledge, and are duty-bound to employ all means necessary to prevent potential judgments against the clinic, whether a lawsuit has been filed or not)?

    This is why I don’t blame doctors. Unless you’re private practice, I just don’t think you have that much control.

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