Avoiding medical errors when hospitalized: 5 things to know before surgery

Researchers at Johns Hopkins published a study in the journal BMJ last month that examined the rates of medical error-related deaths in the United States. In their analysis, these researchers reviewed data on nearly 35 million hospital admissions and calculated that nearly 200,000 deaths per year were due to medical error. Based on Centers for Disease Control and Prevention (CDC) rankings, this would rank medical errors as the third leading cause of death in the U.S. today.

While there is some debate in the medical community as to the accuracy of this number and exactly how it was calculated -- there were mathematical models and extrapolation of data involved -- the study does send a sobering message—there are far too many errors occurring in medicine today.

As both a health care consumer as well as a health care provider, I find these statistics to be quite disturbing.

What are causes of medical error?

The reasons for medical errors today are varied. One source is clearly human error- poor clinical decisions that are occasionally made by a health care provider can lead to negative outcomes.  However, in my opinion, one of the biggest sources of medical errors are more significant "system-type errors."

System errors may include poor communication within a health care facility, issues with patient handoffs and transfers between units, and checks and balances within the electronic medical record system. System errors often occur due to poor protocol design, interruptions and distractions in the health care environment as well as complexity issues (too many steps and too many people involved in a single task).

Avoiding medical errors is a team effort. The most important thing that you can do as a patient or family member is become a part of your own health care team—be a part of the plan and the discussion of your own care—BE ENGAGED.

Here are the Questions that YOU need to ASK both before and during your hospitalization for surgery:

1.      Ask about the skill (and procedure volume) of the surgeon and research his/her background

It is clear that doctors who do larger volumes of a particular procedure are most often better at the job and have better outcomes. It is important to find a physician that has impressive professional credentials as well. Make sure that the doctor has been board certified in the past. In addition, identify a physician that is a leader in his/her field. By doing your homework, you are able to make sure that you have the most qualified person providing your care in the operating room.

2.      Ask WHY you are having the procedure and WHAT are the alternatives

A good physician will explain the procedure to you in detail—the best physicians will also discuss the alternatives to a particular surgical procedure and what to expect in terms of outcomes with each option. You want a physician to offer an opinion, but make sure that the opinion is based on data from clinical trials.  Having these discussions will help make sure that you are choosing the very best treatment for your particular problem.

3.      Ask WHAT are the risks and at what rate do complications occur

Once you choose a particular treatment plan or surgical procedure, it is vital that you know what the risks are and fully understand potential complications. Informed consent is an important part of the treatment process. Ask your surgeon to provide you with resources to read or videos to view in order to get a better idea of what to expect before, during and after your surgery.

4.      Before agreeing to any TEST, ask Why the test is being done and how it will change management

Doctors LOVE to order tests.  It is important to make sure that any test that you agree to have will have an impact on your care—If a test is ordered, the result should help you and your doctor make a decision as to how to proceed with your care.  Make sure to ask about the risks of a particular test. Some tests have actual health risks and you must make sure that the risk of having the test does not outweigh the benefit of the findings the test may provide.

5.      When someone brings you a medicine, ask WHAT it is, and Why you are taking it.

Some of the most common medical errors involve medication errors. It is important that before you take ANY medicine in the hospital that you ask your nurse exactly WHAT the medicine is, what it does for you, and why you are being asked to take it. If the staff cannot provide you with these answers, refuse to take the medicine until you speak with your doctor. Ask about the dose, and, if the dose is different from what you are expecting, make sure to alert the nursing staff right away.

Ultimately, Safety is a priority—Advocate for Yourself

Everyone in health care strives to provide only the best outcomes.  Medical errors unfortunately do occur and sometimes these errors are associated with significant morbidity and mortality. While studies such as the one recently published in the BMJ are often sensationalized, many improvements have been made in systems designed to avoid errors. However, medicine still has a long way to go in order to further decrease the rate of medical errors. It is essential that all health care consumers diligently participate in their own care and ask questions—especially when hospitalized. In cases where you are unable to advocate for yourself appoint a friend or family member to do so.

Kevin R. Campbell, MD, FACC, is an assistant professor of medicine, division of cardiology at University of North Carolina.