US surgeons make thousands of errors each year reports new study

Robin Wulffson MD's picture
never events, medical malpractice, surgical errors, death, injury, cost
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According to a new study, US surgeons make more than 4,000 errors each year. The errors are termed “never events” because they never should have happened. Never events include such things as leaving a sponge in the abdomen or operating on the wrong leg. The study was published online on December 18 in the journal Surgery.

The study authors note that surgical never events are being used increasingly as quality metrics in healthcare in the United States. However, little is known about their costs to the healthcare system, patient outcomes, or the characteristics of the providers involved. Therefore, they designed a study to define the number and magnitude of paid malpractice claims for surgical never events, as well as associated patient and provider characteristics.

The researchers accessed data from the National Practitioner Data Bank, which is a federal repository of medical malpractice claims. By law, hospitals are required to report events that result in a settlement or judgment to the database. The investigators identified malpractice settlements and judgments of surgical never events, including retained foreign bodies (i.e., sponge left in), wrong-site (i.e., operating on the wrong leg), wrong-patient, and wrong-procedure surgery. Payment amounts, patient outcomes, and provider characteristics were assessed.

A total of 9,744 paid malpractice settlement and judgments for surgical never events occurring between 1990 and 2010 were identified. Malpractice payments for surgical never events totaled $1.3 billion. Mortality occurred in 6.6% of patients, permanent injury in 32.9%, and temporary injury in 59.2%. Based on literature rates of surgical adverse events resulting in paid malpractice claims, the investigators estimated that 4,082 surgical never event claims occur each year in the United States. Increased payments were associated with severe patient outcomes and claims involving a physician with multiple malpractice reports. Of physicians named in a surgical never event claim, 12.4% were later named in at least one future surgical never event claim.

A breakdown of never events:

  • Foreign object left behind: 49.8%
  • Wrong procedure: 25.1%
  • Wrong site 24.8%
  • Wrong patient 0.3%

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Between 1990 and 2010, malpractice payments for the aforementioned never events reported to a database totaled $1.3 billion. The mean payment was$133,055. Wrong procedures were the costliest never events, with a median payment of $106,777. The lowest payouts were for foreign objects left behind, with a median payment of$33,953.

The researchers concluded that surgical never events are costly to the healthcare system and are associated with serious harm to patients. They noted that patient and provider characteristics may help to guide prevention strategies.

For years, hospitals have been working for years on safety programs to reduce never events, including “timeouts” before surgery to make sure they have the right patient or are about to operate on the right body part. New technology, such as bar-coding and wand-like scanners waved over a patient, allows surgical teams to account for all sponges and other products used in a procedure. Other steps include using indelible ink to mark the site of the surgery before the patient goes under anesthesia.

Take home message:
This study reports that a significant number of never events occur each year. Hopefully, reports like this will reduce their number; however, it is unlikely that the number of never events will be reduced to zero. Errors are more likely to occur when healthcare workers are fatigued. For example, never events are more likely to occur when the surgeons and other healthcare professional are called in for an emergency procedure in the middle of the night after working a long and grueling day.

Reference: Surgery

See also:
Death more likely in crowded emergency departments
New book addresses the serious issue of physician burnout
Job burnout high among US physicians reports new survey
Federal government proposes to slash graduate medical education funding

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