Researchers question the message in IOM’s medical errors report
Many HIM professionals still seeing cultural changes
A message issued by the Institute of Medicine (IOM) of the National Academies in Washington, DC, last November was "hot and shrill," opponents of the report say, such as the American Hospital Association (AHA) in Chicago. "It shouts about death and disability in U.S. hospitals: Preventable adverse events are a leading cause of death,’ and at least 44,000, and perhaps as many as 98,000, Americans die in hospitals each year as a result of medical errors.’"
The report gained national media attention, and Congress began hearings. Organizations such as the AHA quickly announced campaigns to try to reduce medical errors. Software companies publicized products that could help with the effort.
But was the study flawed? Researchers from the Indiana University School of Medicine in Indianapolis said that is a possibility.
"The unstated corollary — reinforced [in the report] by the death rate from motor vehicle collisions juxtaposed with the death rate from adverse events — is that eliminating preventable adverse events also will eliminate the deaths," the researchers wrote. Their article was published in the July issue of the Journal of the American Medical Association (JAMA).
"Unlike most people who step into motor vehicles, most patients admitted to hospitals have high disease burdens and high death risks even before they enter the hospital," the researchers said. "Although some hospital deaths are preventable, most will occur no matter how many accidents’ we avoid. Of course, medical errors are never excusable, but the baseline death risk has to be known and factored out before drawing conclusions about the real effect of adverse reactions on death rates, preventable or otherwise."
The studies discussed also were observational and not designed to describe causal relationships, according to the report.
Some health information management (HIM) professionals say they were surprised by the numbers listed in the report.
"I first wondered about the [institute’s] definition of medical error and if the person who did the statistics had an agenda," says Gwen Hughes, RHIA, a practice manager for the American Health Information Management Association (AHIMA) in Chicago. "[In my experience], I’ve generally observed that physicians practice good medicine."
In a rebuttal to the Indiana researchers, one health care professional argues that the IOM report is actually on target. "Three reasons suggest that the IOM report did not exaggerate the extent of medical injury and death," wrote Lucian L. Leape, MD, in the same issue of JAMA. Leape is an adjunct professor of health policy in the Harvard School of Public Health in Boston.
First, despite the limits of record reviews, it is unlikely the reviewers found adverse events that did not exist, Leape said. Second, neither of the large studies examined the extent of injuries that occur outside of the hospital. Finally, when prospective detailed studies are performed, error and injury rates are almost invariably much higher than indicated by the large record-review studies.
Although the debate over the IOM study may continue, no one can argue that it will have long-term effects on health care. "[The report’s] long-term impact will result from the validity of its message that errors can be prevented by redesigning medical work," Leape wrote.
"Some of the impacts of the study might be a change in facilities’ cultures so that reducing medical errors is more of a focus," Hughes says.
Performance improvement plans may be reprioritized to focus on falls, medication errors, and incident reports. Hospitals also may spend more money on the development and implementation of systems to manage errors, such as computer systems and alerts, she adds.
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