When it comes to improving the safety of health care, part of the challenge is that hospital patients now are much sicker and care is more complex than a generation ago, experts say. "You have to be quite ill to get into the hospital in the first place. It's a much more vulnerable population," Classen says. "The hospital patient today is like the ICU patient 20 years ago — much more complex, many more things going on, many more medications being given."
The study looked at nearly 800 patient records, measuring errors in three ways. One analysis found only four errors, one standard system identified 35 — and the third found a whopping 354. Some patients experienced more than one mistake, and older patients and those with more complex medical conditions were at higher risk.
And these errors didn't occur in mediocre hospitals, either. The study involved three high-quality teaching hospitals that were not named but were described as having "advanced patient safety programs, initiatives, and research projects."
Not all of the errors are fatal or catastrophic, the researchers say, and sometimes patients themselves can help head off problems. Patients and families should know what medications they are taking, understand the risks of procedures, and bring even minor changes or symptoms to the attention of doctors and nurses, Classen says. That little rash, that unfamiliar pain, that moment when a patient slipped but didn't quite fall, may be nothing to worry about — or it could be a warning. Many problems can be treated or corrected before they get worse.
Robert Wachter, M.D., a safety expert at the University of California San Francisco division of hospital medicine, says the study is a reminder that preventing mistakes is harder than it sounds.
"You put in place checklists or a computer system, and you think you'll clean things up a lot," he says. "But it turns out you clean things up a little."
Reducing errors will require better tools, ongoing education and a change, he says, in how hospitals and the people who work in them think about safety and risk.
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Joanne Kenen is a Washington writer who specializes in health policy issues.