One Pagers | Mar 01, 2003
Susan Dovey, MD, MPH; Larry Green, MD; Ed Fryer, PhD; Robert Phillips, MD, MSPH
In two studies about medical errors, family physicians reported health, time, and financial consequences in nearly 85 percent of their error reports. Health consequences occurred when the error caused pain, extended or created illness, or placed patients, their families, and others at greater risk of harm. Care consequences included delayed diagnosis and treatment (sometimes of serious health conditions such as cancer), and disruptions to care that sometimes even resulted in patients needing care in a hospital. Other important consequences were financial and time costs to patients, health care providers, and the health system generally. However, sometimes no consequence was apparent.
The studies used a broad definition of “error” that made sure any error could be included, regardless of whether it could cause harm to patients. The definition deliberately related to any error or mistake rather than to “preventable adverse events” or “sentinel events.” Family physicians were encouraged to report devastating and apparently trivial events, because even common mishaps not usually regarded as important medical errors might sometimes have devastating consequences. The accompanying table shows the number (and percentage) of reports that included at least one consequence. Consequences more often were revealed by qualitative analysis of the story told in each report than by family physicians’ responses to direct questioning. Each case may be associated with more than one consequence, but in 120 reports, no consequence was recorded or implied.
| Consequence | U.S. FPs (n=416) |
FPs from 5 Other Countries (n=356) |
Total (n=772) |
|---|---|---|---|
| None reported | 79 (19.0%) | 41 (11.5%) | 120 (15.5%) |
| Health consequences, including: | 156 (37.5%) | 206 (57.9%) | 362 (46.9%) |
| Patient/others at increased risk* | 88 (21.2%) | 85 (23.9%) | 173 (22.4%) |
| Patient upset | 21 (5.0%) | 33 (9.3%) | 54 (7.0%) |
| Patient suffered physical pain | 13 (3.1%) | 36 (10.1%) | 49 (6.3%) |
| Patient’s health status worsened | 41 (9.9%) | 93 (26.1%) | 134 (17.4%) |
| Care consequences, including: | 146 (35.1%) | 155 (43.5%) | 301 (39.0% |
| Care delayed | 83 (20.0%) | 81 (22.8%) | 164 (21.2%) |
| Patient admitted to hospital | 10 (2.4%) | 12 (3.4%) | 22 (2.8%) |
| Financial & time costs, including costs to: | 90 (21.6%) | 64 (18.0%) | 154 (19.9%) |
| Patients | 65 (15.6%) | 36 (10.1%) | 101 (13.1%) |
| Physicians, pharmacists, staff | 81 (19.5%) | 45 (12.6%) | 126 (16.3%) |
| Health system/ payers | 36 (8.7%) | 31 (8.7%) | 67 (8.7%) |
| FPs = Family Physicians *--No actual harm occurred in these cases, but the medical error unnecessarily placed patients in the position where harm was a real possibility. |
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These data suggest that in comparison with their international colleagues, U.S. family physicians may choose more often to report medical errors that do not hurt their patients physically but do create extra financial burdens. Every error type previously reported—medication errors, laboratory and diagnostic imaging errors, administration and information management errors, even filing mistakes—did sometimes harm patients, place patients at risk of harm, or add unnecessary costs to their care. Moreover, all errors impacted health care providers, making the work of physicians, pharmacists, nurses, and others involved in health care less efficient, more time-consuming, and more wasteful of money than it could be.
Reducing the incidence of medical errors observed by family physicians will improve patients’ safety and health status, and reduce health care costs.
The information and opinions contained in research from the Graham Center do not necessarily reflect the views or the policy of the AAFP.
Published in American Family Physician, Mar 15 2003. Am Fam Physician. 2003;67(5):915. This series is coordinated by Sumi Sexton, MD, AFP Associate Medical Editor.