The health care system of the United States is a loosely structured system composed of many parts (hospital, outpatient, rehabilitation centers, nursing homes, insurance payers etc.) that do not directly communicate within one centralized, nationwide information system. Because of its complexity, errors can be made that adversely affect the individual seeking care. 

An example is medication errors. There are well over 6,800 different medication prescribed along with thousands of health supplements, herbs, ointments, potions and lotions. Each year, according to the National Institutes of Health, 7,000 to 9,000 people die due to medication errors. In addition there are hundreds of thousands of people who suffer side-effects from taking combinations of medication that are not reported.

This article describes the different types of potential problems that can occur and ways that institutions and health care professionals are attempting to decrease errors and hospitalizations, and improve outcomes for all of us.

Definitions

When discussing patient safety, it is essential to use clearly defined terms. An “adverse event” has taken place when any harm occurs from the treatment and not from the disease. 

An error, as defined by the National Quality Forum (NQF), is “the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.” (The NQF is a nonprofit organization with a stated mission of working to improve health care outcomes, safety, equity and affordability.)

Other terms used in the medical literature include “near miss” (an event that did not produce harm, but only because of intervening factors or a last-minute intervention) and “preventable event” (an event that could have been anticipated and prepared for, but occurs because of an error or system failure).

Common types of medical errors

“Diagnostic error” is the most common reason for malpractice claims against physicians or institutions. It is estimated there are over 12 million errors made each year, which could be underreported per the National Library of Medicine. The term refers to either failure to diagnose or a delayed diagnosis. It is estimated that five percent of adults seeking ambulatory care will experience a diagnostic error that has to potential to be harmful or fatal.

Drug error can occur at any point in the process of obtaining a prescription medication and taking it correctly. Incorrect prescribing by the health care practitioner, dispensing errors by the pharmacy, incorrect understanding of how to take the medication, and delayed monitoring of the effect of the drug can all lead to preventable hospitalizations, permanent harm and potential death. 

Many older adults are taking five or more drugs that can lead to potentially harmful drug interactions and adverse side effects.

Testing errors occur due to the breakdown of ordering a test, processing the test in the lab or facility, a mix-up in correct patient reporting, the failure to report a result (lost/misfiled test results) and delayed follow-up with the patient of an abnormal result. The exact incidence of this problem is unclear, but because of the large volume of test results received in a busy practice, it does occur. This can lead to a situation where the patient isn’t notified of an abnormal result and to delays in obtaining further diagnostic testing and treatment.

Care transition communication issues are the leading cause of adverse events and higher medical costs from readmissions to the hospital. Examples of transitions are when a person is discharged from the hospital back to his/her primary care physician, the transfer to a rehabilitation center or nursing home, and communication between physicians. There is the potential for incomplete or incorrect information in the discharge documents. 

What are physicians and hospitals doing to address these issues?

Electronic medical records (EMR) systems 

Hospitals and physician offices are now routinely using EMR software to document all interactions, order tests, prescribe medication and remind the health care provider about needed testing or screening. These systems have decreased errors due to poor handwriting and misinterpretation of names of drugs and dosages. These systems are not perfect and depend on the accuracy of data entered into the system. 

Because many test results are transmitted back to physician offices by digital methods, systems exist that require a designated person in the practice to review the result and then transfer it to the person’s file. Many doctors and hospital systems in our area have created patient ports that allow the individual to view the written results online as well as to communicate questions with the physician without needing a telephone call. 

Hospital-based interventions

Hospitals are responsible for following up on individuals after discharge. Lack of follow-up with a community health care provider is a major reason why a person is readmitted within 30 days. 

Because of EMR systems, written reports are generated at the time of discharge that are shared with the patient and family, along with discharge summaries, laboratory testing and consultant reports, which are sent or transmitted back to the treating doctor. 

Getting a home-alone patient with chronic health problems to find transportation to the clinic or medical office for follow-up remains a persistent problem in our area. One approach that is used more frequently in some practices and hospitals is following up with patients using video technology. The physician and patient “meet” via Zoom to monitor how the person is doing. 

Patient responsibility

An equal part of preventing errors from occurring is for the individual and his/her family to have a clear understanding of the diagnosis and treatment prescribed. Asking for clarification of treatment procedures and follow-up is essential. If English is not the person’s primary language, hospitals and doctor’s offices can provide translation services. 

You need to be a persistent health care advocate for yourself and your family. Understand the risks and benefits of all the medications you are taking and the risks of medical procedures.