Intended for healthcare professionals

Rapid response to:


Medical error—the third leading cause of death in the US

BMJ 2016; 353 doi: (Published 03 May 2016) Cite this as: BMJ 2016;353:i2139

Rapid Response:

Re: Medical error—the third leading cause of death in the US

Using data to extrapolate the proportion of deaths due to human error, Makery and Daniel (Analysis 7 May 2016) estimate that in the USA medical error is the third highest cause of death beaten only by heart disease and cancer. This is a terrifying statistic: we as doctors may be the greatest threat to our patients.

The focus of the article was the limitation of current data sources to capture medical error as a cause of death. I agree in principle that accurate “assessment of the problem is critical to approaching any health threat”. However, I do not think that we can wait until such a data collection system is developed.

I think we need to act now; research and tools from other high risk industries illustrate the relevance of human factors. I believe the limited understanding of human factors amongst the medical community affects the application of the tools available. For example, the WHO checklist is a briefing, a process to create shared situational awareness. It has little value if performed as a tick box exercise. It should be used for “threat and error management” to highlight threats to patient safety (e.g. prone position, list changes, bleeding risk, fatigue, ASA 3 and above…). It aught to open communication between anaesthetic and surgical teams enabling them to share contingency plans.

We audit compliance with guidelines but how often do we assess the usability and accessibility of protocols, the system, team and organisational factors that contribute to error? High reliability organisations seek learning opportunities, they report incidents to learn not to sanction and they learn from other industries. We delivered an inter-agency human factors course for the fire service and healthcare. Discussion around standard operating procedures (SOP) generated new insight - medical personnel were impressed by the risk and safety awareness of the fire service personnel through their use of SOPs. The inter-agency aspect was key to gaining this new insight into error. It was so well received that Aviation Safety week at Manchester Airport will include a two day Inter-agency Human Factors conference, open to aviation, health care and fire service. We need to use what is available to the best of our ability while trying to devise a system of data collection.

Competing interests: No competing interests

12 May 2016
Heather Gallie
Consultant Anaesthetist
Salford Royal NHS Foundation Trust
Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD