By John Reichard, CQ HealthBeat Editor
July 18, 2014 -- Fifteen years ago, a landmark Institute of Medicine report concluding that up to 99,000 Americans needlessly die each year from medical errors grabbed the health policy community by surprise and prompted a national push to improve patient safety.
But despite steps undertaken since then such as checklists to prevent infection, wider reporting of infection rates and payment incentives to reduce unsafe care, the latest estimates of preventable deaths are far higher.
Patient safety advocates hope to launch a new round of policymaking to address the problem.
"Many individuals, hospitals and other health care institutions are working to eliminate medical errors," Lisa McGiffert of Consumers Union told a Senate hearing last week. Nevertheless "millions of Americans are at risk for death and serious injury," she said. "The response by our leaders fails to match the scope of this epidemic."
McGiffert and other witnesses at the Senate Health, Education Labor and Pensions Primary Health and Aging Subcommittee hearing chaired by Bernard Sanders, I-Vt., offered a long list of policy prescriptions. They ranged from establishing a "National Patient Safety Board" akin to the National Transportation Safety Board to a Securities and Exchange Commission-like entity to develop uniform quality of care measures and expanded reporting on rates of preventable medical harm by the Centers for Disease Control and Prevention.
The new effort seems sure to encounter resistance from the hospital industry, which says lawmakers already have granted ample authority to develop quality measures ensuring patient safety.
American Hospital Association spokeswoman Jennifer Schleman said various agencies have taken steps to reduce medical errors and have authority to develop new measures. She cited as examples the Centers for Medicare and Medicaid Services, the Agency for Healthcare Research and Quality, CDC and the Office of the National Coordinator for Health Information Technology.
Witnesses said that despite progress made since the 1999 report, current efforts are too limited and are sometimes ineffective.
Prominent at the hearing was an estimate by John James, founder of Patient Safety America, that up to 440,000 Americans die each year from preventable medical errors in hospitals. Sanders said errors are the third leading annual cause of death in the United States today, behind heart disease at 597,000 and cancer at 574,000.
McGiffert pointed to three studies done in 2010 and 2011 that she said provided "some solid estimates of how often errors and patient infections happen." A Department of Health and Human Services (HHS) inspector general's study found that unsafe care in hospitals contributes to the deaths of 180,000 Medicare beneficiaries in hospitals annually.
A New England Journal of Medicine study in North Carolina found that one in four hospitals patients is harmed by substandard care during a stay. And an April 2011 Health Affairs study found the one in three hospital patients is harmed.
Patient safety expert Peter Pronovost of Johns Hopkins Medicine in Baltimore said "we do not know exactly how many people die needlessly." But he estimates that more than 220,000 preventable deaths occur yearly from unsafe treatment. He acknowledged heavy federal spending to improve adoption of health information technology to improve care but sees little payoff in safety.
Pronovost and his colleagues developed a simple five-item checklist for teams of doctors and nurses follow to prevent "central line" infections in the intensive care unit. Adopted in 100 intensive care units in Michigan, it cut infection rates to essentially zero, according to a study he published in the New England Journal of Medicine in 2006. That checklist is now followed by hospitals nationally and is credited with saving tens of thousands of lives each year.
Pronovost testified that infections linked to a tube inserted into the chest to carry medications are one type of harm from over a dozen harms. Every type of harm has a checklist, every checklist has five to 10 items and each item may occur three or more times per day. "None of the electronic medical record vendors, despite spending billions, displays this information," he said.
Harvard Medical School professor Tejal Gandhi, president of the National Patient Safety Foundation, emphasized that plenty of medical harm occurs outside the hospital.
"Most care is given outside of hospitals, and there are numerous safety issues that exist in other health care settings," Ghandhi said. The biggest problems in primary care are medication safety, missed and delayed diagnoses and transitions of care.
University of Minnesota School of Nursing professor Joanne Disch stressed the importance of engaging patients and their families in the care process, particularly in keeping medical instructions straightforward and in making sure patients follow them when they go from the hospital to the home, for example.
Sanders said he plans measures to address preventable hospital deaths but didn't outline any plans for legislation.