In the 2013 September edition of Journal of Patient Safety Article Asks: Will You Die from the #3 Cause of Death in the USA?

Ask most people what the #1 & #2 causes of death are and they will usually know they are heart disease and cancer. Ask them for the #3 cause and you are likely to hear infections, trauma, or pneumonia but few guess American Healthcare.

But the correct answer is the Hospitals in the US. The Journal of Patient Safety in September of 2013 revealed that between 210,000 and 440,000 people die from hospitalizations in the US each year. Here’s how they come to this conclusion:

To begin, it is important to understand the concept of preventable adverse events (PAE’s). These are unexpected and harmful experiences that occur because high quality, evidence-based medical care was not delivered during hospitalization. PAE’s can be:

  • Immediate – a side effect of a drug, or
  • Delayed for months – contracting hepatitis from dirty needles a few months after hospitalization, or
  • Delayed for years – getting pneumonia because a pneumonia vaccination was not given to a patient receiving a splenectomy years prior.

PAE’s are further categorized into:

  1. Errors of Commission – the wrong action or right action performed incorrectly on a patient.
  2. Errors of Omission – an action needed by a patient was not performed; for instance, a medicine was indicated but not given in a vital situation.
  3. Errors of Communication – for example, two providers failing to communicate clear instructions during surgery; or a provider and patient inadequately reaching an understanding of discharge instructions.
  4. Errors of Context – an example is when a patient is discharged but is unable due to cognitive ability, to perform tasks needed for their safety.
  5. Diagnostic Errors – resulting in delayed, incorrect, or ineffective treatment such as mis-identifying a tumor biopsy as benign when it is actually malignant.

To identify these PAE’s, a systematic review of medical records was performed at hospitals by trained personnel with the Global Trigger Tool (GTT), developed by the Institute for Healthcare Improvement (IHI). The results were then validated by one or more physicians. Four studies with a total of 4,252 records revealed 38 total deaths associated with adverse events. The ratio equates to a death rate from adverse events of 0.89%.

As previously referenced, the September 2013 The Journal of Patient Safety article indicated that there were an estimated 34.4 million hospital discharges in 2007, and the average percentage of preventable adverse events was reported at 69%. Thus, the best estimate from combining these 4 studies is 34.4M discharges × 69% with PAEs × .89% death rate = 210,000 preventable adverse events per year that contribute to the death of hospitalized patients.

According to the Center for Disease Control, death statistics in the US are:

  1. Heart disease: 597,689
  2. Cancer: 574,743
  3. Chronic lower respiratory diseases: 138,080
  4. Stroke (cerebrovascular diseases): 129,476
  5. Accidents (unintentional injuries): 120,859

As you can see, 210,000 deaths puts US Healthcare squarely in the #3 position for annual cause of death.

But even this may be an underestimate.

This conclusion is based only upon medical records. This fails to account for confounders such as poor documentation, complications managed by non-hospital facilities or in the outpatient setting, the “wall of silence” of health professionals altering or omitting critical data when mistakes occur, and the fact some medical errors are not known by clinicians and only come to light during autopsies (rarely performed), to name a few. Thus the actual number of deaths is significantly underestimated by at least 50%, based upon chart reviews, given the high probability of these confounders. The Journal Article therefore estimates the actual number of deaths is closer to 440,000 deaths per year, making medical inpatient errors the number three cause of death in the US by a significant margin.