Zzz A Dangerous Healthcare System

Health care in the United States is not as safe as it should be--and can be. At least 44,000 people,
and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that
could have been prevented, according to estimates from two major studies. Even using the lower
estimate, preventable medical errors in hospitals exceed attributable deaths to such feared threats
as motor-vehicle wrecks, breast cancer, and AIDS. Medical errors can be defined as the failure of a
planned action to be completed as intended or the use of a wrong plan to achieve an aim. Among the
problems that commonly occur during the course of providing health care are adverse drug events and
improper transfusions, surgical injuries and wrong-site surgery, suicides, restraint-related
injuries or death, falls, burns, pressure ulcers, and mistaken patient identities. High error rates
with serious consequences are most likely to occur in intensive care units, operating rooms, and
emergency departments. Beyond their cost in human lives, preventable medical errors exact other
significant tolls. They have been estimated to result in total costs (including the expense of
additional care necessitated by the errors, lost income and household productivity, and disability)
of between $17 billion and $29 billion per year in hospitals nationwide. Errors also are costly in
terms of loss of trust in the health care system by patients and diminished satisfaction by both
patients and health professionals. Patients who experience a long hospital stay or disability as a
result of errors pay with physical and psychological discomfort. Health professionals pay with loss
of morale and frustration at not being able to provide the best care possible. Society bears the
cost of errors as well, in terms of lost worker productivity, reduced school attendance by children,
and lower levels of population health status. A variety of factors have contributed to the nation's
epidemic of medical errors. One oft-cited problem arises from the decentralized and fragmented
nature of the health care delivery system--or "nonsystem," to some observers. When patients see
multiple providers in different settings, none of whom has access to complete information, it
becomes easier for things to go wrong. In addition, the processes by which health professionals are
licensed and accredited have focused only limited attention on the prevention of medical errors, and
even these minimal efforts have confronted resistance from some health care organizations and
providers. Many providers also perceive the medical liability system as a serious impediment to
systematic efforts to uncover and learn from errors. Exacerbating these problems, most third-party
purchasers of health care provide little financial incentive for health care organizations and
providers to improve safety and quality.