How to prevent medical errors

'Patient safety' as a recognized concept didn't really exist until about 20 years ago. Why?

For a long time most doctors and nurses thought of complications as the inevitable byproduct of treating sick people. Medicine was simpler. We had fewer oper­ations, fewer medications, fewer de­vices, so there wasn't as much opportunity for things to go wrong. You don't make mistakes doing heart bypass oper­ations if you're not doing heart bypass operations. Modern health care is in­cred­ibly complicated. Someone once sat and watched what happened to a person in the intensive-care unit. They had 180 things done to them in a single day. We also lacked adequate data about safety until a study published in 1991 showed that 4 percent of patients in hospitals were harmed by their treatment, and two-thirds of those were because of errors. We function at a very high level 99 percent of the time, but even 1 percent is a lot of errors.

Why don't doctors and nurses just stop messing up?

The normal human reaction is to say the person just wasn't careful enough. That's what we said for 100 years and look where it got us. It's true that errors happen because a human being screwed up, but when you look below the surface you almost always find a flaw in the system that made it happen. This is the central insight of the patient-safety movement. If you ask nurses to measure doses by taking medication out of a vial, a certain number of times they'll make a mistake. If the medication comes in prepackaged unit doses, you eliminate that possibility. Another example: I was a surgeon for 25 years, and I was always anxious that I was going to operate on the wrong side, but it never occurred to me that it was anybody's responsibility but my own. Now we've made it everybody's responsibility—the doctor, the nurse, the anesthesiologist, even the patient. If you get your knee replaced at some point you will have to write your initials on the side that's going to be operated on. And that has significantly reduced the incidence of wrong-site surgery.

Have we made progress?

We've made a lot of improvements. We have a list of 34 safe practices that hospitals should implement, and when they do, they reduce injury. There has been a dramatic reduction in central-line infections and in ventilator-associated pneumonia. There are restrictions on on-duty hours so doctors aren't so sleep-deprived. But we still haven't gotten to where we need to be. It turns out that changing systems isn't easy. Hospital executives say they've made safety a primary concern, but they haven't really. The proof is that the ones who really have done this have seen an 80 to 90 percent reduction in medical harm.

What can we as patients do to help ensure our safety?

It's the health care organization's job, not the patient's, to create an environment where everybody functions as safely as possible. But patients can look for health care organizations where there really is a team approach to safety. Insist on understanding what's being recommended and having all the options explained to you. In the hospital, try to pay attention to what's going on. Now, that's kind of hard to do when you're sick, so bring a friend or relative if you're not able. After all, you're the one with the most at stake.