Behind heart disease and cancer, medical error has been identified as the third leading cause of death in the U.S., according to a recent study published in the BMJ, an international peer reviewed medical journal.
The study by researchers Martin A. Makary and Michael Daniel, estimates that about 400,000 people die annually in the U.S. due to medical error. The problem has gone largely unnoticed, however, the study says, because the Centers for Disease Control and Prevention (CDC) relies on the use of an International Classification of Disease (ICD) code to record the cause of death on death certificates.
"The annual list of the most common causes of death in the United States, compiled by the Centers for Disease Control and Prevention (CDC), informs public awareness and national research priorities each year. The list is created using death certificates filled out by physicians, funeral directors, medical examiners, and coroners," said the authors of the study.
"A major limitation of the death certificate is that it relies on assigning an International Classification of Disease (ICD) code to the cause of death. As a result, causes of death not associated with an ICD code, such as human and system factors, are not captured," they explained.
They said that the science of safety now demonstrates how communication breakdowns, diagnostic errors, poor judgment, and inadequate skill can directly result in patient harm and death.
After an analysis they said they were able to estimate that more than 400,000 deaths are cause annually in the U.S. due to medical error.
"A 2004 report of inpatient deaths associated with the Agency for Healthcare Quality and Research Patient Safety Indicators in the Medicare population estimated that 575 000 deaths were caused by medical error between 2000 and 2002, which is about 195 000 deaths a year," they wrote.
"Similarly, the US Department of Health and Human Services Office of the Inspector General examining the health records of hospital inpatients in 2008, reported 180,000 deaths due to medical error a year among Medicare beneficiaries alone. Using similar methods, Classen et al described a rate of 1.13%. If this rate is applied to all registered US hospital admissions in 2013 it translates to over 400 000 deaths a year," said the researchers.
"We have estimated that medical error is the third biggest cause of death in the US and therefore requires greater attention. Medical error leading to patient death is under-recognized in many other countries, including the UK and Canada," they continued.
The study noted that about 117 countries code their death statistics using the ICD system as the main indicator of health status but it "has limited ability to capture most types of medical error."
"At best, there are only a few codes where the role of error can be inferred, such as the code for anticoagulation causing adverse effects and the code for overdose events. When a medical error results in death, both the physiological cause of the death and the related problem with delivery of care should be captured," the study said.
"To achieve more reliable healthcare systems, the science of improving safety should benefit from sharing data nationally and internationally, in the same way as clinicians share research and innovation about coronary artery disease, melanoma, and influenza," the researchers added. "Sound scientific methods, beginning with an assessment of the problem, are critical to approaching any health threat to patients. The problem of medical error should not be exempt from this scientific approach. More appropriate recognition of the role of medical error in patient death could heighten awareness and guide both collaborations and capital investments in research and prevention."