1 in 20 patients experience preventable harm while receiving medical care, study finds

About 1 in 10 patients experience some kind of harm while receiving medical care and in about half of those cases — 1 in 20 — the harm is preventable, according to a study published this week in the BMJ.

The study, a large systematic review of existing scientific literature on the topic, examined data from 66 previously published studies involving 70 different groups of mostly adult patients — 337,025 patients in total — from countries around the world.

Thirty-three of the patient groups in the studies were in the United States, and all of the studies were conducted within the past 19 years.

The studies identified 28,150 patients who had been harmed during the course of their medical care. Of those, 15,419 had experienced harm that was preventable.

In 12 percent of the cases, the preventable harm was severe enough to result in permanent disability or death.

“Our findings affirm that preventable patient harm is a serious problem across medical care settings,” the authors of the study conclude. The authors also say their findings are applicable across all countries.

As the authors point out, the disability and death caused by preventable medical harm is equal to that caused by multiple sclerosis or cervical cancer in developed countries or by tuberculosis or malaria in developing countries.

Defining patient harm

There is no consensus about the definition of patient harm, but the Institute for Healthcare Improvement defines it as “unintended physical injury resulting from or contributed to by medical care (including the absence of indicated medical treatment), that requires additional monitoring, treatment or hospitalization, or that results in death.”

The authors of the systematic review note that the World Health Organization defines patient harm as that which occurs during the “provision of healthcare, rather than an underlying disease or injury, and may be physical, social or psychological.”

About half (49 percent) of the preventable harm cases identified in the systematic review were related to prescribed medications or other treatments. Almost a quarter (23 percent) were linked to surgical procedures. Another 16 percent were associated with healthcare-related infections and missed or inaccurate diagnoses.

The study also found that such harms were more likely to occur while patients were receiving advanced and specialized medical care, particularly when they were being treated in a hospital’s intensive care or surgical unit.

Patients receiving obstetrical care were the least likely to experience a preventable harm, according to the review.

“We need strategies in place to detect and correct the key causes of patient harm in health care,” said Maria Panagioti, the study’s lead author and a senior lecturer (associated professor) at the University of Manchester, in an email exchange with NBC News. “Our study finds that most harm relates to medication, and this is one core area that preventative strategies could focus on.”

Taking active steps to minimize harm

The review comes with limitations. The studies were not uniform in how they were designed or in how they defined and identified preventable patient harm.

Still, as experts from Harvard University and the London School of Economics write in an accompanying commentary, the review’s findings raise “serious concerns about the safety of health systems,” given how much of medical harm is “totally preventable.”

“Moving forward, efforts need to be focused on improving the ability to measure preventable harm,” they write. “This includes fostering a culture that allows for more systematic capturing of near misses, identifying harm across multiple care settings and countries, and empowering patients to help ensure a safe and effective health system.”

What patients can do

Individuals can take steps to lower their risk of experiencing a preventable medical error. As the Agency for Healthcare Research and Quality (AHRQ) emphasizes, doing so involves becoming “an active member of your health care team.”

“That means taking part in every decision about your health care,” they add.

AHRQ offers a long list of things people can do to reduce their risk, including the following for patients who find themselves in a hospital:

• If you are in a hospital, consider asking all health care workers who will touch you whether they have washed their hands. Handwashing can prevent the spread of infections in hospitals.

• When you are being discharged from the hospital, ask your doctor to explain the treatment plan you will follow at home.This includes learning about your new medicines, making sure you know when to schedule follow-up appointments, and finding out when you can get back to your regular activities. It is important to know whether or not you should keep taking the medicines you were taking before your hospital stay. Getting clear instructions may help prevent an unexpected return trip to the hospital.

• If you are having surgery, make sure that you, your doctor, and your surgeon all agree on exactly what will be done. Having surgery at the wrong site (for example, operating on the left knee instead of the right) is rare. But even once is too often. The good news is that wrong-site surgery is 100 percent preventable. Surgeons are expected to sign their initials directly on the site to be operated on before the surgery.

• If you have a choice, choose a hospital where many patients have had the procedure or surgery you need. Research shows that patients tend to have better results when they are treated in hospitals that have a great deal of experience with their condition.

• Speak up if you have questions or concerns. You have a right to question anyone who is involved with your care.

For more information:You can read the systematic review in full on BMJ’s website. You can also read the full list of AHRQ’s suggestions for how patients can lower their risk of medical error on that agency’s website.