Patient Safety

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Rarely Mentioned Medical Mistake: Patients Harmed by High Rates of Misdiagnosis

By Sandra G. Boodman, Kaiser Health News

(Getty Images)

(Getty Images)

Until it happened to him, Dr. Itzhak Brook, a pediatric infectious disease specialist at Georgetown University School of Medicine, didn’t think much about the problem of misdiagnosis.

That was before doctors at a Maryland hospital repeatedly told Brook his throat pain was the result of acid reflux, not cancer. The correct diagnosis was made by an astute resident who found the tumor  —  the size of a peach pit  —  using a simple procedure. The experienced head and neck surgeons who regularly examined Brook had never tried it. Because the cancer had grown undetected for seven months, Brook was forced to undergo surgery to remove his voice box, a procedure that has left him speaking in a whisper. He believes that might not have been necessary had the cancer been found earlier.

“I consider myself lucky to be alive,” said Brook, now 72, of the 2006 ordeal, which he described at a recent international conference on diagnostic mistakes held in Baltimore. A physician for 40 years, Brook said he was “really shocked” by his misdiagnosis.

Misdiagnosis “happens all the time … This is an enormous problem.”

But patient safety experts say Brook’s experience is far from rare. Diagnoses that are missed, incorrect or delayed are believed to affect 10 to 20 percent of cases, far exceeding drug errors and surgery on the wrong patient or body part, both of which have received considerably more attention.

Recent studies underscore the extent and potential impact of such errors. To cite just two examples: Continue reading

6 Factors That Help Save Lives In A Disaster

From Olympic Park to the Boston Marathon to Texas

The New Yorker’s Atul Gawande writes often and well about medicine. This week, he described how disaster planning and training in hospitals saves lives. This morning he added a series of tweets:

Continue reading

Hospital Ratings Are In The Eye Of The Beholder

By Jordan Rau, Kaiser Health News

(Courtesy: Kaiser Health News)

(Courtesy: Kaiser Health News)

How good a hospital is St. Mary Mercy Livonia Hospital in Michigan? It depends on whom you ask.

The Leapfrog Group, a respected nonprofit that promotes patient safety, gave an “A” to the hospital. The company Healthgrades named it one of America’s best 50 hospitals.

But the Joint Commission, a nonprofit organization that accredits hospitals, and U.S. News and World Report omitted St. Mary from their best hospital lists. Consumer Reports gave it an average safety score of 47 points out of 100, citing high numbers of readmissions, poor communication with patients and excessive use of scans. Medicare, which has a new program rewarding hospitals for meeting certain quality measures, is reducing St. Mary’s payments by a fraction this year.

Is your head spinning yet?

As ratings multiply, more and more hospitals have something they can brag about. A third of U.S. hospitals won at least one distinction from a major rating group or company.

Evaluations of hospitals are proliferating, giving patients unprecedented insight into institutions where variations in quality can determine whether they live or die. Many have similar names, such as “Best Hospitals Honor Roll,” “America’s Best Hospitals” and “100 Top Hospitals.” Some states have created their own report cards. In California there are more than a dozen organizations offering assessments on hospital quality.

But those ratings, each using its own methodology, often come to wildly divergent conclusions, sometimes providing as much confusion as clarity for consumers. Continue reading

Checklists and More: Systems Matter in Aviation, Can Save Lives in Health Care, Too

High standards for aviation safety led to the grounding of the Boeing 787. A systems approach to patient safety is spreading to health care. (brownpau/Flickr)

High standards for aviation safety led to the grounding of the Boeing 787. A systems approach to patient safety is spreading to health care. (brownpau/Flickr)

Hippocrates may have told doctors to “First, do no harm” more than 2,000 years ago, but it’s taken almost that long for modern medicine to “begin approaching the problem of medical mistakes as a system and create a concerted movement,” says Dr. Robert Wachter, Associate Chairman of the Department of Medicine at UC San Francisco.

In a report published Tuesday intended to move American health care closer to a safer system, Wachter and his colleagues identified the top ten strategies that doctors and nurses should embrace to help protect patients from unintended harm.

The goal is to move doctors, hospitals and nurses toward a recognition that even the most dedicated doctors and nurses can make mistakes, so health care needs systems that help catch errors before patients are harmed.

Health care providers can read the complete list of strategies here, but for the casual reader, they include items such as: