Medical Errors in U.S. Healthcare: Types and Prevention

Introduction to Medical Errors

Medical errors, no matter how much healthcare professionals may be reluctant to admit they occur, do happen — and for some, with alarming regularity. Preventing and reducing these errors not only improves patient safety and reduces patient fears, but also provides peace of mind for healthcare professionals themselves.

Errors, even in medicine, are an unpleasant fact. No person is infallible, and there is always a margin for human error. As two researchers note, "Nobody in your organization deliberately makes a mistake. In fact, it's human nature to avoid things that will harm you or someone else. Still, people commit errors that lead to tragic results" (Turner and Kurtz, 2008). These authors identify two primary reasons people make mistakes: a lack of technical expertise and a lack of teamwork. They also maintain that individuals and teams must recognize and understand where they tend to make mistakes in order to correct them (Turner and Kurtz, 2008). Both of these factors can be controlled, and errors can be reduced, if healthcare workers recognize how and why mistakes happen and remain vigilant against them.

Common Types of Medical Errors

The types of errors committed range widely — from miscommunication between labs, doctors, and patients, to surgical instruments left inside a patient after an operation, to misdiagnosis and poor patient understanding. As one author notes, "Communication failures are a central factor in medical errors. According to an article in Annals of Internal Medicine, invasive procedures done on the wrong patients occur far more frequently than reported" (Berntsen, 2004, p. 28). This is only one example among many. Other documented errors include miscommunication regarding patient diagnosis, performing surgery on the wrong patient, conducting tests or X-rays on the wrong person or body part, misinterpretation of written instructions and prescriptions, and the administration of inappropriate medications. Many of these errors could be reduced through better communication practices, and healthcare professionals need to recognize the critical importance of communication at every level — from the doctor's office to surgery, pharmacy, and beyond.

Many of the most common medical errors recur repeatedly, making them memorable to the public. Sponges and other surgical devices are frequently left inside patients, which can lead to massive infection and even death. Patients are often given medication overdoses due to misinterpretation of a doctor's orders, or they may receive entirely wrong information about their treatment. Wrong limbs or organs may be removed or replaced, and patients may be misidentified. Lab results can be confused or incorrectly reported, and nurses may overlook written orders. In all of these instances, better communication could have prevented the problem — and often this includes communication with the patient. Patients are frequently well-informed about their own illnesses and conditions, yet mistakes sometimes occur even after patients have raised concerns about their care. Healthcare professionals sometimes dismiss patients, assuming they know more than the patient does, which is not always the case. To prevent errors, healthcare professionals must be more open to communication with one another, with patients, and with patients' families, who often possess valuable knowledge that doctors and nurses underestimate.

A far less recognized form of medical error is the "near miss" — an incident that could have resulted in a serious error but was caught in time. Near misses occur far more often than many people realize, and they are frequently documented as "incident reports" within the healthcare industry. As Berntsen explains, "Most hospitals have some version of these forms for internal quality tracking. Also, depending on the size of individual hospitals, anywhere from 30 to 300 incident reports are generated each month. Large health care systems with multiple facilities can track as many as 1,000 events each month" (Berntsen, 2004, p. 44).

Near Misses and Incident Reporting

That represents a striking number of cases that came dangerously close to becoming serious medical errors, prevented only by a caregiver's timely response or, sometimes, by chance. Near misses are an extremely important component of any healthcare facility's quality assurance program because they reveal just how accident- and error-prone a facility may be, and they can even identify which departments or individuals carry the highest risk of future errors.

How can a healthcare staff effectively reduce medical errors within their facility? Turner and Kurtz argue that team debriefing is central to this effort. They write, "Effective debriefing is the key to long-term sustainable improvements in patient safety and care. It is only through debriefing that an organization, team, or individual will improve consistently over time" (Turner and Kurtz, 2008). According to these authors, debriefing should be confidential, non-threatening, structured, and timely. Sessions should take place as soon as possible after the event or error, and they should allow participants to acknowledge their own mistakes or missteps so they can identify and address them going forward.

Conclusion

Medical errors occur, they will always occur, and that means healthcare staff must remain constantly vigilant in order to manage and eliminate as many errors as possible. Good communication and teamwork can significantly reduce medical errors, as can honest acknowledgment of a team's or individual's weaknesses. It is far better to admit vulnerability and prepare for the possibility of error than to conceal weakness and allow errors to compound. Healthcare workers must understand that they are part of a team, and they need to work together, communicate effectively, and remain alert to potential errors — so that mistakes occur far less often than they would without sustained worker vigilance.