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10 most expensive errors in healthcare settings

| Physician | December 6, 2010

Medical errors have been in the news lately.  An Ontario provincial review probing unnecessary surgeries at a Windsor hospital found significant concerns with the work of a pathologist involved in a mistaken mastectomy case.

In the US, avoidable medical errors added $19.5 billion to the nation’s healthcare bill in 2008, according to a claims-based study conducted for the Society of Actuaries (SOA). The report lists the 10 most expensive errors in healthcare settings.

Here are the 10 most expensive types of medical errors:

      1. Pressure ulcers–374,964 errors, $10,288 per error and $3.858 billion total.

 

      2. Postoperative infections–252,695 errors, $14,548 per error, $3.676 billion total.

 

      3. Mechanical complication of a device, implant or graft–60,380 errors, $18,771 per error, $1.133 billion total.

 

      4. Postlaminectomy syndrome–113,823 errors, $9,863 per error, $1.123 billion total.

 

      5. Hemorrhage complicating a procedure–78,216 errors, $12,272 per error, $960 million total.

 

      6. Infection following infusion, injection, transfusion, vaccination–8,855 errors, $78,083 per error, $691 million total.

 

      7. Pneumothorax–25,559 errors, $24,132 per error, $617 million total.

 

      8. Infection due to central venous catheter–7,062 errors, $83,365 per error, $589 million total.

 

      9. Other complicaitons of internal (biological) (synthetic) prosthetic device, implant and graft–26,783 errors, $17,233 per error and $462 million total.

 

    10. Ventral hernia without mention of obstruction or gangrene–53,810 errors, $8,178 per error and $440 million total.

They most expensive errors on a per-error basis are:

      1. Postoperative shock–$93,682.

 

      2. Infection due to central venous catheter–$83,365.

 

      3. Infection following infusion, injection, transfusion or vaccination–$78,083.

 

      4. Gastrostomy complications, infection–$66,765.

 

      5. Complications of transplanted organ–$66,658.

 

      6. Infection and inflammatory reaction due to internal prosthetic device, implant and graft–$62,265.

 

      7. Tracheostomy complications–$56,479.

 

      8. Gastrostomy complications, mechanical–$55,219.

 

      9. Infusion or transfusion reaction–$51,686.

 

    10. Gastrostomy complications–$49,115.

The report highlights the need for hospitals to reduce errors.  It also serves as a wake-up call to patients and family members.  Now that you know where the errors occur, you know a bit more what questions to ask when you or a loved one is hospitalized.

Adapted from a blog post that appeared on White Coat, Black Art.

Brian Goldman is an emergency physician and author of The Night Shift: Real Life In The Heart of The E.R., published by HarperCollins.

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  • doc99

    Most if not all of what are listed as “Errors” are not errors at all, but rather known complications.

  • http://blog.headache-treatment-options.com/appliedobjectivism/ David Allen, MD

    I remember when errors were actual errors. NOW, as doc99 has already pointed out – any complication is listed as an error!? I have a feeling this is the ‘waste, fraud and abuse’ that Obama and his ilk had in mind when they thought they could reduce costs in Medicare. It is a con game, with doctors being scapegoated. Do you think these definitions will find their way into any legal cases? Oh, I think so.

    If Medicare lists this type of thing as an ‘error’, there will be even more physicians refusing to accept new patients.

  • paul

    if you can’t find enough medical errors to make your point…. easy! just expand your definition of “error”

  • steve weaver

    Calling at of these things errors is bogus.

  • Chris Bent, MD

    I am only a resident and I have to admit that some of those are a stretch. Device complications, hemorrhage during surgical procedures, whats the point of M+M conferences?. I guess all those things on the 6 page informed consents our patients sign for possible complications are all errors and hospitals and physicians should never ever be paid for known complications of procedures. Thats not to say we physicians are infallible and should not strive to reduce the rates, but to equate pressure ulcers with a hemorrhage during CT surgery is ……….

  • SmartDoc

    “Errors” in this article are all complications. Only a dishonest
    Medicare/Medicaid bureaucrat would mislabel them errors.

    Operating on the wrong lower extremity is an error. Post-op infection is a known complication.

  • ElaineM

    “Post-op infection is a known complication.”

    If it’s passed on to the patient by a caregiver who ignores basic hygiene protocol, it’s reckless endangerment.

  • http://onhealthtech.blogspot.com/ Margalit Gur-Arie

    Yes, but are there ways to reduce the rates of such complications? Are there any simple things that can be done consistently to yield less infections and less pressure ulcers, for example? Or are we doing everything we can and the number of complications is now optimal and unavoidable?

  • doc99

    Right about now, the most expensive medical error seems to be enrolling in medical school.

  • Finn

    I have to agree with ElaineM; post-op, post-injection, and catheter infections aren’t complications just because they’re common. They’re the result of errors in infection control procedures.

  • alex

    “post-op, post-injection, and catheter infections aren’t complications just because they’re common. They’re the result of errors in infection control procedures.”

    You are confusing the issue. SOME post-op and urinary catheter infections can be due to errors in infection control. This does not mean they all (or even the majority) are. In fact, if you look at the data on the impact “strict adherence” to “best practices” actually has on surgical site infections, you’d be hard pressed to say that that many infections are due to not following the best evidence. Human beings are not meant to have sterile skin and our best attempts at forcing the issue will never be 100% effective.

  • Primary Care Internist

    We should be very careful, particularly as physicians, at even lightly endorsing medicare’s definition of “errors”. This is a slippery slope. Without any reasonable pushback on this nonsense, I foresee ER docs being dinged for the following “errors” in the future:

    re-hospitalization or ER transfer after discharge from an ER

    missed ruptured aortic aneurysm

    missed PE

    missed MI

    etc. the list potentially goes on and on, and primarily benefits bureaucrats who don’t see/treat patients, and trial lawyers. none of this crap helps patients. They continue to get post-op infections and pressure sores. They continue to have delirium and hypoglycemia in the hospital. Old ladies continue to fall.

    Now we’re even seeing lawyer ads on TV trying to draw in clients who’ve had known side effects of medications (???) Doesn’t anyone see just how absurd that is? Just because it’s becoming so common, doesn’t mean our senses should just become numb to this crap.

  • gzuckier

    Well, I’m sure we all know enough to go to primary sources rather than rely on media reports, so, from
    http://www.soa.org/files/pdf/research-econ-measurement.pdf
    we find (I admit to being surprised) that they did in fact consider that errors are a subset of injures which are a subset of complications;
    “A group of clinicians with extensive experience in clinical inpatient medical record review reviewed this list of diagnoses. Based on clinical experience and judgment, they estimated how often each type of injury was likely to be associated with a medical error as opposed to an unavoidable consequence of the underlying disease state despite best practice. These clinicians classified injuries into the categories shown in Table 5 based on the likelihood that they were associated with a medical error. We then applied the midpoint of each range of likelihood of medical error to the frequency of each medical injury to establish the rate of medical error. For example, in the injury group that is associated with medical error in between 65 and 90 percent of occurrences, we multiplied the number of injuries by 0.775 to derive the estimated number of errors. Consistent with the finding in the Layde et al study, we reduced all frequencies by 10 percent for false positives. We did not increase our estimate for false negatives.”

  • Dr Wingate

    Need to define errors before you can begin to devise strategies to reduce them…a good place to start is AHRQ’s PSNET http://psnet.ahrq.gov/glossary.aspx and IHI.
    T

  • pao

    Dysfunctional behaviors persist & resist in atmosphere’s of Denials–>distortions–> deceptions & resulting shifting of Blame ,shame & personal responsibility. We cannot effect change including quality improvements until we accept ownership & the desire to “DO better”. Each of these points have been repeatively documented with measureable outcomes and improvements in status with equally documentatable ,measureable quality improvements. Let’s stop looking for excuses to continue less than admirable outcomes! Let’s get real!

  • http://www.evendoctorscry.com alvin reiter m.d.

    As a doctor and surgeon for over 30 years I do not find any of the above errors.Any incision i make can lead to infection,permanent nerve or function damage and of course hemmorhaging.A facial implant can reject,get infected or distort etc.To find real errors that cost a life read my book”Even Doctors Cry” http://www.evendoctorscry.com.It may make you all better doctors.

  • docguy

    pressure ulcers are not always preventable, at the time of christopher reeve’s death apparently he had pressure ulcer, clearly the man had about the best care you can get and it still occurred so not everything is 100% preventable.

    i can be perfect and still stuff happens, people aren’t machines or computers and have unwanted and unusual responses to different interactions.

  • L. Mueller MD FACS

    Where can I find an explanation as to why an “error” that results in a pneumothorax costs the system >$24K? As a thoracic surgeon, I have spent a career treating this “error,” and this could only originate from a subclavian venipuncture. Other causes of a pneumothorax, like a gunshot wound, elective surgical procedure, etc, could hardly be considered an error. The actual cost of a 28 Fr chest tube, insertion set, plastic waterseal suction system or a Heimlich valve and a few CXR’s has to be less than $1K, possibly $2K – $3K max, and the MD reimbursement is clearly significantly < $1K. Add a few days hospitalization on a ward at $1K per, and $5K would be a reasonable total at these inflated "costs." So, how does this reported study arrive at an average cost of $24K?
    For these types of reports to be credible, the data source should be readily available to those of us responsible for treating this high cost error, so I ask you, Kevin, where can the explanation be found? I believe that most of your readers would be interested in this type of information, and as a thoracic surgeon, I would like to know what I am doing wrong that has worked so well for my patients for many years. Thank you.

  • http://twitter.com/#!/RubyRN Ruby Poole

    The healthcare system is broken. Hospitals are staffing units with less nurses & other support staff. Nurses are trained to prevent errors, complications and recognize when things aren’t going the way they should. The nurse & nursing staff are the physician’s eyes & ears. Unfortunately, the nurse’s workload extends beyond what is humanly possible to meet all patient needs. Hospitals, doctors, nurses, and patients must realize the crucial role that nurses have in the outcome of the patient’s hospital stay. Hospitals must change current practice of routinely staffing to minimally meet the patient’s neeeds. Staffing needs must be measured by the acuity of patients and not just a one -size- fits- all crunched number.

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