Survey examines medical errors
First detailed look at frequency, type in a key specialty
Nearly half of ear, nose, and throat surgeons who responded to a survey said they were involved in, or knew of, a recent medical error, providing the first comprehensive look at the frequency and type of errors in a crucial specialty.
Otolaryngologists at Boston's Children's Hospital, Tufts University School of Medicine, and Helsinki University Central Hospital in Finland randomly mailed an anonymous survey to 2,500 of their colleagues last summer and fall. Of the 466 surgeons who replied, 45 percent reported that a medical error had occurred in their practice in the previous six months. The errors occurred in all phases of patient care from diagnosis and testing, to surgery and post-operative care. Seventy-eight errors, or 37 percent, seriously harmed patients, while 9 were fatal.
Researchers said they were surprised by some of the results, which are to be published today in the journal Laryngoscope. Surgeons, for example, reported injuries to seven patients during endoscopic sinus surgery, which takes place in a narrow cavity close to the eyes and brain; two of those patients were blinded. Because individual doctors are so rarely involved in mishaps during this surgery for chronic sinusitis, they assume such errors are unusual overall, said Dr. David Roberson, a surgeon at Children's Hospital and one of the authors. "I've never seen anyone lose their sight before, but two in the last six months, my God," Roberson said.
"The take-home message to doctors is that they need to ask and get information about errors and adverse events specific to their practice" if the profession is going to make improvements.
The medical profession's growing focus on medical errors dates back to 2000, when the Institute of Medicine reported that errors injure more than one million patients yearly, and kill 98,000. At the time, the "reaction of most physicians was one of incredulity," wrote Lucian Leape a professor at the Harvard School of Public Health, in an editorial accompanying the otolaryngology study.
But the profession's efforts to reduce medical errors accelerated, he wrote, and some medical specialties like anesthesia, emergency medicine, and intensive care have made significant progress. Some hospitals also are installing computerized near-miss systems to more easily spot trends that can lead to dangerous medical errors.
However, Leape wrote, most surgeons have not been involved in these activities, regarding "safety and quality improvement as the province of others." He said the otolaryngology study provides an important step toward developing more knowledge about surgical errors in the specialty.
Dr. Michael Zinner, head of surgery at Brigham & Women's Hospital and a researcher into medical errors in surgery, said that surgeons for a long time have analyzed their own errors at so-called morbidity and mortality conferences at their hospitals, in which doctors gather to review mistakes and talk about improvements.
"That has been going on for almost 100 years," Zinner said. "What has not been going on until recently is adding more structure to understand the rate and incidence of errors and complications. That's what the profession is doing now, looking system-wide for patterns and errors that we think are correctable."
Zinner and his colleagues conducted a study in 1999 in which they reviewed more than 15,000 charts of patients in Utah and Colorado, and found that 3 percent of patients having surgery suffered adverse events -- two-thirds of these events were judged to be preventable. Now they're developing a template of how to predict which patients are at risk.
For example, surgeons may be more likely to leave sponges accidentally inside patients if the patient is obese, the surgical plan changes mid-operation, or the surgery is an emergency. When such elements are present, the hospital might consider X-raying patients after surgery to double check.
Roberson, the coauthor of the errors in otolaryngology study, said that he and his colleagues wanted to develop a way to classify different types of errors so surgeons would know trouble spots. Testing errors, for example, accounted for 10.4 percent of all errors reported. In one case, an office staff member meant to order an X-ray for a child from a computerized drop-down menu. Instead, the employee mistakenly ordered a study requiring the young patient to have anesthesia.
In 13.7 percent of the errors, the patient got the wrong medication. In one case, a nurse went out into the lobby and called a patient named Jones, but a patient name Johnson misheard and went back into the doctor's office, Roberson said. The patient got the wrong allergy serum. The researchers, who also made recommendations on how to reduce errors, suggested staff members require each patient to check his or her own vial before injection.
Roberson said doctors should involve patients in preventing errors. "I say to families, 'you're the final endpoint,' " he said. " 'You remind me we're doing two things today, or we're doing this type of tube or the left tonsil. It's in my notes, but I do ten cases a day.' "
Liz Kowalczyk can be reached at kowalczyk@globe.com. 