Medical Breakthroughs: In Safe Hands? Part 1: Improving Patient Safety

BACKGROUND: A 1999 study by the Institute of Medicine determined between 45,000 and 98,000 people die each year from medical mistakes. Medication errors alone are estimated to be responsible for as many as 7,000 deaths.

Behind the medication errors are the problems of medications with similar names, bad handwriting by doctors on prescriptions, and too many new drugs for doctors to remember as they go from patient to patient.

Another common cause of medical mistakes include impaired physicians who let their stress become too much and either they make mistakes or drive nurses away, which brings with it increased risk.

Marilynn Rosenthal, Ph.D., a medical sociologist from the University of Michigan and author of Medical Mishaps, points to four main causes of medical mistakes. She says first there is the patient and all the complexities the patient brings with him, including complaints and how those complaints are explained and other factors that may be going on with the patient's health.

Then there is the uncertainty in medicine. Rosenthal says only about 40 percent of all medicine is agreed upon, meaning that doctors agree that this is how a specific condition should be diagnosed and treated. This leaves a lot of medicine that is uncertain.

Then there is the organization, the hospital. The hospital can be considered a "high-risk organization" based on all the high-risk activities that take place there.

Finally, there is the team of physicians. Rosenthal says you have to consider the team's experience, how well they work together, their level of fatigue, their level of stress, etc.

With all these combined, there is clearly no easy solution to overcoming medical mistakes. And, while many are turning to improved "systems", Rosenthal says not everything can be solved by a new system.

ADDRESSING IMPAIRED PHYSICIANS: Studies show at any given time 15 percent to 23 percent of all physicians are experiencing a professional or personal life crisis that impairs their ability to provide care.

One way this stress can manifest is the way doctors treat those around them, often becoming argumentative. A survey of nurses found 92 percent of nurses say they have witnessed disruptive behavior by physicians. The result is that many nurses are leaving the practice and blaming bad behavior by doctors.

The nursing shortage being faced in the United States appears to have a direct impact on patient safety. With fewer nurses, the nurse to patient ratio is worse, nurses become stressed themselves, and they are overworked, leading to mistakes.

To address this issue, JCAHO, the hospital-accrediting group, has put a new rule into effect. In order to be accredited, hospitals are required to have treatment available to help the physician when stress becomes a problem.

RESIDENT FATIGUE: Another issue that is problematic enough to require changes is the issue of resident fatigue. In some specialties, residents often work as many as 120 hours a week and can spend countless hours on call at any one time.

A recent study found being awake for 24 hours affects mental alertness the same as a blood alcohol of point 1, considered too drunk to drive in all states. A new mandate expected to be approved in Feb. 2003 will limit resident work hours to 80 a week averaged over four weeks with certain specialties being able to extend that to 88 hours, and residents will be limited to 24-hour shifts with an allowance of 6 additional hours to finish up administrative-type duties.


National Patient Safety Foundation
American Medical Association
Department of News & Information
515 N. State Street
Chicago, Illinois 60610
(312) 464-5970

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