I have returned to posting on my blog after several months. Multiple other projects have kept me away. In December, my article for Skeptic magazine appeared in the winter quarter issue of that publication, Volume 18, Number 4. Its title is "Still Unsafe: Why the American Medical Establishment Cannot Reduce Medical Errors" and is available on the Web. Here is what a prominent medical editor and researcher who declined attribution said, " It's really well done and I am in complete agreement with you on the topic." Emboldened by this success, and with my arguments enhanced by three additional pieces of evidence, I wrote a one thousand word op-ed piece for the LA Times entitled "When Medical Errors Kill" which appeared in the Sunday, March 17 print version of that paper. It is also available on the Web.
It's the purpose of this post to bring readers up to date on recent important developments in the patient safety efforts going on in this country. There are three of them and I shall devote a post to each. Briefly the first two are well documented academic studies. One is from Boston Children's Hospital which showed the error reducing effects of careful, thorough sign offs between pediatric residents at the change of shifts. The second is a study from Ontario, Canada that failed to find a benefit of surgical check lists in hundreds and hundreds of patients from several hospitals. Both papers were from top tier medical journals, the Journal of the American Medical Association and the New England Journal of Medicine, respectively.
The third communication and the main subject of this post is a report of the Department of Health and Human Services of May of this year. Unfortunately, for the reasons mentioned below, it is not a scientific paper. If its claims are true, it is unique in that it shows a 9 per cent drop in adverse events in American hospitals over a two year period from 2010 to 2012. If correct, it is the first across the board improvement in patient injury and mortality since the great promise of the landmark publication of the Institute of Medicine, To Err is Human, in 1999. That report said if the systems method, an approach I have tried to debunk in my writings, were used, we would see a drop in adverse events of 50% in five years. That never happened. After the five year period was up, two major studies of 2010 that I quote regularly showed that there was no improvement, and possibly a worsening through 2008. That is why I am so skeptical about the HHS report even though it relates to a subsequent time period. To reiterate, it has been my contention all along, based on well grounded data from the Federal Government and the Harvard School of Public Health, that it is the incompetent American physician who is responsible for the greatest number of preventable harms to the American patient. Please see my earlier posts for the discussion of that crucial subject.
I have further doubts about the May HHS report. Most importantly, there was no peer review, a process in which more than one anonymous expert unaffiliated with the authors had gone over the paper thoroughly. The report lacks the usual and customary statistical analysis which denotes whether or not the hypothesis of the authors--in this instance, that the number of adverse events is declining--is supported by the data. There is no section, obligatory in all medical research papers for many years, where the authors criticize their own paper's limitations and potential sources of bias. There is only the implied disclaimer in that the results from 2012 are described as "preliminary". Preliminary reports are sometimes published as a warning or encouragement to the members of the profession when investigators come upon a striking new finding. Further, in contrast to the formal papers that are the standard of medical journals, no authors of the May HHS report are listed. When authors have to risk their reputations by putting their names on a report, we are likely to find something closer to the truth than otherwise.
In a report to the Senate subcommittee on Primary Health and Aging made this past month (July, 2014), a summary was made of the progress in reducing adverse events in American hospitals in the fifteen years since the publication of To Err is Human. Citing the same two 2010 reports I usually allude to, Dr. Ashish Jha of the Harvard School of Public Health said that little progress has been made. He and his colleague from Hopkins, Dr. Peter Pronovost, made no mention of the dramatic claim of the May HHS report.
So we are left with a report that is at variance with the already published medical journal papers on the subject of harmful errors in American hospitals and which does not rise to the level of an acceptable scientific manuscript. Perhaps HHS will be more forthcoming. It would have been better if it had published its results in a medical journal. If true, the 9% reduction is a remarkable and laudable advance in patient safety. Right now its significance is indeterminate.