Last week we discussed John T James’ study that he claims shows 400 thousand
American Hospital inpatients die of preventable event.
Dr. James claimed that he uses a good tool to determine preventable (negligent) deaths, the Global trigger that records abnormal events or lab work. Doing a meta analysis of four studies done in the past 6 years he estimates 400,000 hospital preventable/negligence deaths a year.
Annual deaths in America are listed and categorized for the US here:
The total deaths annually are 2,400,000
Of those, 715,000 were deaths in the hospital. Average age at death in the hospital 72 -73 over the past 10 years.
Now let’s consider. Dr. James says 57% of all hospital deaths in America are preventable???
Now do you wonder how it is that people get published–well a patient safety journal loves somebody like Dr. James. He makes headlines with data torturing. I might politely say that his claims have little to recommend them.
Recall that the big patient safety studies also had their problems as admitted by the leader of the Harvard group.
Troyen Brennan M.D., J.D. — a lead Harvard researcher on the two studies that were the backbone of the IOM report and the source of the negligence death numbers that scared so many — asserted in an essay (April 13 2000) in the New England Journal of Medicine (NEJM) that the research of the Harvard group was weak and was being misused by the IOM.
–”I have cautioned against drawing conclusions about the numbers of deaths in these studies.”
–”The ability of identifying errors is methodologically suspect.”
–”In both studies (New York and Utah/Colorado) we agreed among ourselves about whether events should be classified as preventable…these decisions do not necessarily reflect the views of the average physician, and certainly don’t mean that all preventable adverse events were blunders.”
Outcome bias drives these studies, when a patient dies there is a tendency to find fault. Sometimes the patient dies because they are very old and terminally ill. When they are dying things that appear to be fixable go wrong. Desk review of the chart may not be adequate to determine if the death was preventable or the result of negligence.
Imagine how the numbers will swell if selective withdrawal of treatment is encouraged.