Medical error: creeping from words to action

BMJ 2001; 322 doi: (Published 03 March 2001) Cite this as: BMJ 2001;322:0

Ten years ago a BMJ editorial argued that Britain needed a large study of the prevalence of medical error (29 September 1990, p 621). The editorial followed the publication of a study of more than 30 000 records of admissions to New York hospitals. It found that almost 4% of admissions were associated with an error and that 14% of patients who experienced an error died in part because of the error. The BMJ calculated that if the same error rate applied in British hospitals then 300 000 patients each year experienced an error and 45 000 died in part because of it. The Times picked up this comment, and the then president of the Royal College of Physicians of London criticised the BMJ for spreading alarm.

Today we publish a small survey of adverse events in British hospitals that shows that 11% of patients experience an adverse event, half of which are preventable, and a third of events lead to moderate or greater disability or death (p 517). Other studies in Australia and the US have found similar rates. It seems as if the BMJ's estimates of 10 years ago may have been conservative, and today's president of the Royal College of Physicians of London writes that if the NHS is serious about reducing errors then a large scale study is needed (p 501).

Although the New York study was published 10 years ago, medical error did not rise high on the agenda in the US until the publication of a report from the Institute of Medicine in 1999. Here in Britain the chief medical officer of England has drawn attention to the problem, but medical error has not been a top priority. But—in a classically British manner—the problem may now be rising up the agenda because of several high profile errors reported in the media (p 562).

The first step to reducing medical errors seems to be to admit that they are common, but a dispute in Brighton shows that the NHS still finds that hard (p 562). The next step is to change the culture, and a British Airways pilot describes how this has happened within airlines (p 563). The captains, the “Atlantic barons,” were asked to put aside their hard earned status and accept questioning from “junior” pilots, a shift from autocrat to team player.

To reduce error we all need to recognise that we are part of a system, not lone players. Error has to be designed out of the system (p 548). If we don't do that then both patients and doctors will suffer. For one tragedy of error is that the doctor is likely to suffer as well as the patient. There are two victims.


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