
How Many Die from Medical Mistakes in U.S. Hospitals? (2013) - apsec112
https://www.propublica.org/article/how-many-die-from-medical-mistakes-in-us-hospitals
======
anon4this1
As a Doctor, the potential for improvement begins from very basics. For
instance - a radiologist sees a funny looking line on an xray and reports
"this is probably nothing, but we should repeat the xray in 6 weeks to make
sure." Sometimes these requests slip through the cracks and in a fraction of
cases the patient presents 2 years later with terminal cancer from their
metastatic lung Ca.

Ensuring blood thinners are prescribed post coronary bypass surgery or
stenting is another one. It should happen every time, but sometimes by human
error it may not.

A good startup idea would be to make a hotlist of the top ~1000 of these
obvious, preventable errors, combine IT data sources to predict when they
might be occuring, and have checking systems in place to prevent them. If it
worked even adequately, hospitals would be seen as negligent for not using
such a system.

~~~
rzzzt
There was an article making the rounds here on HN about medical checklists,
similar to what pilots use for takeoff and landing procedures, for example.
Can't remember good keywords to search for, though...

~~~
hidroto
[https://en.wikipedia.org/wiki/The_Checklist_Manifesto](https://en.wikipedia.org/wiki/The_Checklist_Manifesto)

Another example of doctors advocating checklists.

~~~
maxerickson
This article is by the same author:

[http://www.newyorker.com/magazine/2007/12/10/the-
checklist](http://www.newyorker.com/magazine/2007/12/10/the-checklist)

I like the quote from the doctor doing a lot of the work with checklists,
answering a question about when they will be widely adopted in medicine:

 _“At the current rate, it will never happen,” [Pronovost] said, as monitors
beeped in the background. “The fundamental problem with the quality of
American medicine is that we’ve failed to view delivery of health care as a
science. The tasks of medical science fall into three buckets. One is
understanding disease biology. One is finding effective therapies. And one is
insuring those therapies are delivered effectively. That third bucket has been
almost totally ignored by research funders, government, and academia. It’s
viewed as the art of medicine. That’s a mistake, a huge mistake. And from a
taxpayer’s perspective it’s outrageous.”_

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finid
The problem, and the root cause of many medical mistakes, is medical staff not
getting enough sleep.

I know of nurses who could barely keep their eyes open while driving to work.
And that's because they just finished a shift at a different hospital.

At a time, a friend of mine had to be picking up his wife from work, because
he was afraid of what might happen if she drove herself.

So let's fix the sleep deprivation problem.

~~~
teej
Some studies show that sleep deprivation is not a major factor in medical
mistakes. Others indicate that patient hand-off is a more important area for
medical mistakes.

This isn't to say that doctors shouldn't sleep, only to suggest that having
doctors work longer to reduce patient hand-off is a legitimate and justified
choice.

My ideal would be to improve the process and technology behind hand-off enough
so that there isn't any justification to have doctors work longer hours. That
is how you fix the sleep deprivation problem. Not seeing my wife for 30 hours
because she is on call is no fun.

> "Overall, the risks of adverse outcomes of elective daytime procedures were
> similar whether or not the physician had provided medical services the
> previous night."

[http://www.nejm.org/doi/full/10.1056/NEJMsa1415994](http://www.nejm.org/doi/full/10.1056/NEJMsa1415994)

> "Implementation of the handoff program was associated with reductions in
> medical errors and in preventable adverse events and with improvements in
> communication, without a negative effect on workflow."

[http://www.ncbi.nlm.nih.gov/m/pubmed/25372088/](http://www.ncbi.nlm.nih.gov/m/pubmed/25372088/)

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HillaryBriss
If I'm not mistaken, in Kaiser hospitals, each time a drug is administered to
an in-hospital patient, the patient's wristband is electronically scanned with
a handheld gun to re-verify that this is in fact Patient X with condition Y
who needs treatment Z.

~~~
gameshot911
Correct, both the patient _and_ the medication are scanned and confirmed
against the electronic order before administration.

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devine_sparkles
I have a few comments:

My main experience as a patient tells me that one major area of improvement
comes from the utter lack of coordination there in on the part of hospitals,
insurance companies, and pharmacies to get me the meds I've been prescribed.
How many hours do I need to be on the phone? This is "just" at home, though.

In the hospital, I often have just as hard a time to get all my meds because
some of my meds are so specialized that the in hospital pharmacy doesn't have
them, and I have to bring them from home. If I come in due to an emergency, I
am likely to forget them. Thus, additional problems can come about from not
having these meds.

Those aren't what most would consider mistakes on the parts on doctors or
health care professionals, though, that's institutional blockers to my health
care. Do they get counted in this?

As for mistakes on the part of human workers, I wonder just how much is from
workers not washing their hands. Anecdotally, a lot of people I know complain
that doctors are loathe to do that and other cross-infection control
procedures that are simple, but repetitive.

Another barrier I see (although not exactly a "mistake" from one person) to
good care is how much effort this can all take, and that it often necessarily
means taking time off work. Taking too much time off means you may get fired,
etc. Is this taken into account?

I suppose many of my concerns are not direct causes--not getting your meds or
getting to the doctor to figure out a problem early on means you miss the
opportunity to prevent or fix an easier problem. Then have to deal with it as
a full-blown disaster, which means more complicated care, and more
opportunities for mistakes in the OR.

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peter303
At a CU medical shool lecture I just saw a paper cited when the infection rate
was reduced from 3% to no incidents (two quarters) after the teams used
checklists for a certain complicated procedure. That is one of many
improvement tools being adopted.

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mmclinn
I'm working on a startup to help with this problem. My belief is doctors don't
have enough opportunity to practice the complex tasks of diagnostics and
treatment planning. Right now best-practice for medical training involves
expensive life-size manikins and dedicated simulation rooms with real staff.
My goal is a realistic software simulation of the emergency room with a wide
variety of patient scenarios to let students and docs easily practice in a
setting where failure is okay.

~~~
cdelb
Care to share the details of your startup? Lot's of ER docs involved with sim
in my group of friends.

~~~
mmclinn
Sure.

[http://minervasoftworks.com/Minerva](http://minervasoftworks.com/Minerva)

I'm dedinitely looking for medical collaborators, so a mention to your friends
would be appreciated.

