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Annual Cost of Medical Errors Estimated at $17.1 Billion

Analysts with the actuarial firm Milliman estimate that measurable medical errors cost the nation $17.1 billion in 2008. Pressure ulcers, postoperative infections, and post-laminectomy syndrome were the most frequently occurring errors identified in their examination of medical claims data. Ten types of errors were the most costly, accounting for two-thirds of annual medical error costs. Postoperative infections, pressure  ulcers, and mechanical complication of a noncardiac device, implant, or graft topped the most costly list of errors. Data is provided on the incidence,  expense per error,  and the national aggregate cost for each of the most frequent and most costly error types.

Source: Van Den Bos J and others. The $17.1 billion problem: the annual cost of measurable medical errors. Health Affairs, vol. 30, no.4, Apr. 2011, pp. 596-603. http://content.healthaffairs.org/content/30/4/596.abstract

Wrong site surgery: 1 case/year in typical 300 bed hospital

What is the incidence of wrong site surgery?

[The following is a selection from the health care literature on this topic.  A comprehensive search would yield more citations.]

(Stahel, et al., 2010) reviewed over 27,000 cases of adverse occurrences self-reported by physicians from 2002 to mid-2008 and found 25 instances of wrong-patient and 107 instances of wrong-site procedures.  Causes of the wrong patient errors were communication problems and errors in diagnosis.  Causes of the wrong-site errors were primarily errors in judgment and lack of a surgical time out. 

(Malloy and Hughes, 2008) summarized the literature in a concise chapter about wrong site surgery.  They discuss incidence, as well as techniques for avoiding this type of medical error.

(Clarke, et al., 2007) studied the incidence of wrong site surgery based on over 430,000 surgical operations performed in Pennsylvania from mid-2004 until the end of 2006.  Based on these extensive data from both hospitals and ambulatory surgery centers, the authors estimate that the typical 300-bed hospital is likely to have one wrong-site surgery event per year.  Wrong side surgery was the most commonly occurring type of wrong site surgery.  The majority (56%) of the reported events were near misses, caught before any care was rendered.  A table included in this article itemizes suggested process improvement actions to help prevent this type of medical error.

(Kwaan, et al., 2006) analyzed 20 years of data from a malpractice insurer covering about 30 Massachusetts hospitals and developed an incidence rate.  The authors found 40 instances of wrong-site surgery during the study period, from which they estimated that the incidence for non-spine wrong-site surgery is 1 in 112,994 operations.  They mention that the incidence of retained foreign bodies is 10 times more likely to occur than wrong-site surgery. 

Surgical time outs

Lee (2010) studied the implications of instituting an extended surgical time out prior to anesthesia induction for pediatric patients at Kaiser Permanente Bellflower Medical Center.  The children did not seem to experience distress during the time out.  Although staff found the extended time outs to be helpful in improving communication, this approach did not eliminate wrong-site surgery.  Of greater efficacy were changes in the site marking process, which now may only be done by the surgeon.

(Altpeter, T., et al., 2007) describe the surgical time out practice adopted at The University of Louisville Hospital, which serves as a ‘reflective pause’ or ‘preop briefing.’  Besides focusing on confirming the patient identification and operative site, the hospital added an additional 5 components to the STO process.   

(Backster, et al., 2007) describe the effort at one hospital to expand the surgical time out into a ‘preparatory pause,’ which covers avoidance of perioperative risks.  The authors developed an estimate of the financial benefit of instituting an extended surgical time out of $900 per patient.

Sources

Altpeter, T., and others.  Expanded surgical time out: a key to real-time data collection and quality improvement.  Journal of the American College of Surgeons;204(4):527-532, Apr. 2007.  http://www.surgicalpatientsafety.facs.org/research/altpeter.pdf

Backster, A., and others.  Transforming the surgical ‘time out’ into a comprehensive ‘preparatory pause.‘  Journal of Cardiac Surgery;22(5):410-416, Sept./Oct. 2007. 

Clarke, J.R., Johnston, J., and Finley, E.D.  Getting surgery right.  Annals of Surgery;246(3):395-405, Sept. 2007.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1959354/pdf/20070900s00006p395.pdf

Kwaan, M.R., and others.  Incidence, patterns, and prevention of wrong-site surgeryArchives of Surgery;141(4):353-358, Apr. 2006.

Lee, S.L.  The extended surgical time-out: does it improve quality and prevent wrong-site surgery?  The Permanente Journal;14(1):19-23, Spring 2010.  http://www.thepermanentejournal.org/files/Spring2010/TheExtendedSurgicalTimeOutDoesItImproveQualityandPreventWrongSiteSurgery.pdf

Malloy, D.F., and Hughes, R.G.  Wrong site surgery: a preventable medical error, in: Hughes, R.G. (ed.) Patient Safety and Quality: An Evidence-Based Handbook for Nurses.  Rockville, MD: Agency for Healthcare Research and Quality, Apr. 2008, Chapt. 36.  http://www.ncbi.nlm.nih.gov/books/NBK2678/pdf/ch36.pdf

Seiden, S.C., and Barach, P.  Wrong-side/wrong-site, wrong procedure, and wrong-patient adverse events.  Archives of Surgery;114(9):931-393, Sept. 2006. 

Stahel, P.F., and others.  Wrong-site and wrong-patient procedures in the universal protocol era: analysis of a prospective database of physician self-reported occurrences.  Archives of Surgery;145(10):978-984, Oct. 2010.