Medical errors in the PICU

Hospitals can be dangerous places, and the subject of medical errors has been getting a lot of attention over the past couple of years. The movement really got going with widely-reported study from the Institute of Medicine, which calculated that anywhere from 44,000 to 98,000 people die each year as a result of medical errors. That is a staggering number on the face of it, but you should understand that the definition of a “medical error” is an inexact one (hence the range in the IOM report).

Some errors are clear, the ones which generate headlines, such as giving a patient a drug she is known to be allergic to or performing surgery on the wrong body part. Other errors, though, are much softer. Diagnostic errors, for example, such as failing to make the correct diagnosis, are much more difficult to classify. Doctors have our own term for the old saying that “hindsight is 20/20”: we call it the “retrospectoscope.” Looking through this fanciful instrument makes things crystal-clear, but only in retrospect. We live life forward, not in reverse.

Still, the medical safety movement has made enormous strides over the past decade. It turns out that many patient safety measures are actually quite simple things to implement. For example, simple checklists turn out to be easy and effective ways to make sure things are done correctly.

One of the most problematic aspects of the entire patient safety movement is the sticky issue of blame. The ground-breaking IOM report’s title was “To Err is Human,” and it is. Nothing done by humans will be completely error-free. Yet the way to make things safer for all patients is to devise a way of monitoring and reporting errors without making healthcare personal afraid to report them, either because they will be disciplined or sued. Although I think we still need a way to make individuals accountable for their actions, a systems approach, such as the airline industry has done, is the best way to make the system safer for everybody.

It can work in medicine as well as in air traffic control towers. A well-known example of this is anesthesia. Getting an anesthetic is many times safer for patients these days than it was decades ago because the specialty of anesthesiology took a systems approach to accomplishing that.

The high-tech, high pressure environment of the PICU makes it a place particularly susceptible to errors, and I have seen them happen. The widely-reported incident with Dennis Quaid’s child is an example. I can’t quote you any statistics, but it is my personal impression that the patient safety movement of the past decade have reduced their number and severity.

Speaking of checklists, the American Academy of Pediatrics has an excellent one here, entitled “Twenty Tips to Help Prevent Medical Errors in Children.” It covers medications, surgeries, and hospital stays. I recommend it to you.


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