http://bmj.com/cgi/content/full/323/7303/9/a
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News
Hospitals must inform patients of errors
Deborah Josefson
Hospitals in the United States have been told that they must inform patients
of medical errors, in new rules issued by the Joint Commission on
Accreditation of Healthcare Organizations (JCAHO), a non-profit
making group that monitors 11000 hospitals and
19000 healthcare organisations nationwide.
Hospitals that do not comply may lose their accreditation or face steep
fines. Currently only Veteran's Administration hospitals, which care
for US armed forces veterans, are required to inform patients of
medical errors.
The new rules took effect on 1 July and are intended to increase
patient safety. The regulations were developed in response to a
1999 report from the Institute of Medicine estimating that preventable
medical errors kill between 44000 and 98000 hospital patients
each year (BMJ 1999;319:1519). The institute's report found that
most of these errors were the result of system problems rather than
poor performance by individual providers.
A congressional report additionally found that over 95% of medical errors
went unreported. Congressional figures also showed that medication
errors, such as missed dosages, double dosages, and dangerous drug
interactions, are responsible for 777000 deaths or injuries
among patients annually.
Under the new commission regulations hospitals must actively prevent medical
errors and must design patient care processes taking account of
safety issues. Changes in organisation and refinement of information
management systems will be key components of reducing medical error.
Changes such as internal checks to ensure that the correct patient receives
the correct dose of the correct medication will be instituted. Drug
orders will be linked to pharmacy records so that drug interactions
can be checked for. Hospitals and doctors will be encouraged to
report all medical errors, regardless of whether a patient was
harmed by them. Additionally, healthcare providers will be required
to inform patients if they have been harmed in the course of
diagnosis or treatment.
The new standards represent a radical departure from the traditional culture
of medicine. Doctors and hospitals customarily fail to disclose
medical errors to patients. Indeed, a web of silence about medical
errors traditionally prevails, not least because of fear of
malpractice litigation.
Professions have also tended to protect their own members from outside
critics. It is hoped that the increased disclosure may reduce malpractice
lawsuits by promoting better communication between doctors,
hospitals, professional staff, and patients and their families.
Studies have shown that patients who have good relationships with
their doctors are more satisfied with their care and less likely to
sue, even when the doctor or hospital is at fault.
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