March 13, 2013

Medical Harm

Posted in QUICK PRINTS tagged , , at 6:58 pm by PCOSLady

~ Medical harm refers to any systemic failure in the health care system that results in a negative psychological or physical consequence. Medical harm is not limited to iatrogenic illness.
The term “medical harm” was first used after a Harvard Medical study in 1991 concluded that patients incurred a substantial amount of injury from medical management, and the injuries were a result of substandard care. A 1999 report by the Institute of Medicine, “To Err is Human,” further defined the scope of the problem and outlined comprehensive recommendations for reducing harm.
Prevalence ~ In the United States
~ 10% of acute hospital admissions resulted in the incidence of an adverse event.
~ In 1999, it was estimated that 44,000 – 98,000 people die in hospitals each year as a result of medical errors, making it the tenth leading cause of death.
~ In 2000, it was estimated 225,000 deaths from iatrogenic causes, making it the third leading cause of death.
~ Twenty to 30 percent of patients in the United States receive care that is contraindicated.
~ Adults 65 years and older are three times more like than younger adults and 60% more likely than middle-aged adults to experience post-operative respiratory failure following elective surgery even after adjusting for co-morbidities.
~ Few studies have been done to determine medical harm in the clinical or outpatient setting.
Types of medical harm ~ In a clinical setting or hospital
* misdiagnosis – a provider incorrectly identifies a patients condition or disease (ex. a patient is diagnosed with heart burn, a gastro-intestinal condition when he actually has a heart condition)
* under-diagnosis – a provider does not fully identify the cause (ex. a patient with Lyme disease, which is caused by a tick and starts out with vague symptoms like fatigue and joint pain is told he has fibromyalgia)
* overdiagnosis – something benign is identified as happening often with cancer where non-specific cancer marker is identified with the potential that the cancer carries no risk to the patient’s health.
* unnecessary surgery – a provider performs a surgery without utilizing or ruling out less invasive options (ex. a hysterectomy for uterine bleeding before considering a uterine fibroid artery embolization)
* under treatment – lack of appropriate follow-up or treatment, often related to lack of health insurance, or inability of provider to diagnose
* over treatment – a provider provides more interventions than are required (ex. provider prescribes a multiple medications to ensure his patient with epilepsy is seizure free without considering the side effects)
~ ~ ~
~ Patient abuse or neglect is any action or failure to act which causes unreasonable suffering, misery or harm to the patient. It includes physically striking or sexually assaulting a patient. It also includes withholding of necessary food, physical care, and medical attention. It applies to various contexts such as hospitals, nursing homes, clinics and home visits.
~ ~ ~
~ Never events are inexcusable actions in a health care setting, the “kind of mistake that should never happen”. The initial list of 28 events was compiled by the National Quality Forum of the United States. They are defined as “adverse events that are serious, largely preventable, and of concern to both the public and health care providers for the purpose of public accountability.”
Recommended actions following a never event
~ The Leapfrog Group offers four actions as industry standards following a never event:
1. apologize to the patient
2. report the event
3. perform a root cause analysis
4. waive costs directly related to the event

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