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performance on safety, evidence-based practice, and patient satisfaction. 22 It's a New Day in Public Health FDOH Medical Errors: A Public Health Perspective Learner Course Guide Slide 23 #8 Rule for Healthcare Redesign The healthcare system should be PROACTIVE rather than REACTIVE The health system should anticipate patient needs, rather than simply reacting to events. Slide 24 #9 Rule for Healthcare Redesign The healthcare system should be Prudent with resources The health system should not waste resources or patient time. Slide 25 #10 Rule for Healthcare Redesign Clinicians and Institutions should Actively Collaborate & Communicate to ensure an appropriate exchange of information and coordination of care. Clinicians and institutions should actively collaborate and communicate to ensure an appropriate exchange of information and coordination of care. 23 It's a New Day in Public Health FDOH Medical Errors: A Public Health Perspective Learner Course Guide Slide 26 Suggested Areas of Change ‒ Application of evidence to health care delivery ‒ Utilization of information technology ‒ Alignment of payment policies with quality improvement ‒ Preparation of the workforce Based on the premise that redesign of the health care delivery system is dependent on changing the structure and processes of the environment in which health care professionals and organizations function, four primary areas of change were suggested: 1. Application of evidence to health care delivery 2. Utilization of information technology 3. Alignment of payment policies with quality improvement 4. Preparation of the workforce Slide 27 2001 2010 Numerous improvements to safety in health care delivery take place …unfortunately, continue to affect up to of patients worldwide World Health Organization, 2010 The past decade has seen numerous improvements to safety in health care delivery. Unfortunately, health care delivery continues to fall short of what it should be or what is desired. In 2007, the World Health Organization (WHO) reported that medical care errors continued to affect up to 10% of patients worldwide (WHO, 2010). Slide 28 2013 Study PATIENT DEATH from preventable medical errors may be FOUR TIMES HIGHER than has been indicated - Binder, 2013 Recent study from the Journal of Patient Safety indicates death from preventable medical errors may be four times higher than was indicated in earlier reports: as many as 440,000 patients a year. 24 It's a New Day in Public Health FDOH Medical Errors: A Public Health Perspective Learner Course Guide Slide 29 According to the World Health Organization Medical errors claim the spot as the third leading cause of death in the United States; following cancer and heart disease (Binder, 2013) Medical errors claim the spot as the third leading cause of death in the United States; following cancer and heart disease (Binder, 2013). Slide 30 Are the Medical Error Figures Realistic? PROBABLY NOT It is doubtful that the actual number of medical errors is accurately captured. Under-reporting, lack of a universal standardized reporting system, and fear of professional and legal penalties contribute to the hesitancy of health care providers to self-report medical errors or near misses. Slide 31 COST OF MEDICAL ERRORS ‒ $19.5 billion in 2008 ‒ 30% of health care spending ‒ $4.4 billion Medicare cost (Andel, Davidow, Hollander & Moreno, 2012) The national annual cost of medical errors and resulting poor quality was estimated to be as high as $19.5 billion in 2008, which represented 30% of health care spending. Of that annual loss, $4.4 billion was attributed to Medicare cost. 25 It's a New Day in Public Health FDOH Medical Errors: A Public Health Perspective Learner Course Guide Slide 32 Associated Costs ‒ Physical & psychological discomfort for patients ‒ Lost work productivity ‒ Loss of trust ‒ Diminished satisfaction Errors are also costly in terms of physical and psychological discomfort for patients, lost work productivity for patients who require extra care time, loss of trust in the healthcare system by patients as well as diminished satisfaction by patient and health professionals. Slide 33 Where Are They Happening? ‒ 52.5% outpatient setting ‒ 66.6% major injury or death (Bishop, Ryan & Casaline, 2011) In 2009, approximately 10,739 malpractice payments were made on behalf of health care providers; 52.5% of those events occurred in the outpatient setting. Sixty-six percent of outpatient medical malpractice claims involved major injury or death Slide 34 FOUR TYPES OF ERRORS ‒ Diagnostic ‒ Treatment ‒ Preventive ‒ Other Medical errors are commonly typed into one of four categories: diagnostic, treatment, preventive or other. 26 It's a New Day in Public Health FDOH Medical Errors: A Public Health Perspective Learner Course Guide Slide 35 DIAGNOSTIC ERRORS ‒ 7 to 10 billion laboratory tests annually = 70% of medical decisions ‒ Largest fraction of medical errors ‒ Most SEVERE PATIENT HARM ‒ 80,000- 160,000 annually (Saber-Tehrani, Lee, Mathews, Shore, Makary, Pronovost & Newman-Toker, 2013) It is estimated that 7 to 10 billion laboratory tests are performed each year nationally to inform approximately 70% of medical decisions (MMWR, 2005). Researchers from Johns Hopkins have determined that diagnostic errors account for the largest fraction of malpractice claim payouts, cause the most severe patient harm and the highest total of payouts. They estimate the number of patient suffering misdiagnosis-related, potentially preventable, significant permanent injury or death annually in the U.S. ranges from 80,000 to 160,000. They also determined that more diagnostic error claims were rooted in outpatient care than inpatient care (68.8 % vs. 31.2 %) 27 It's a New Day in Public Health FDOH Medical Errors: A Public Health Perspective Learner Course Guide Slide 36 Diagnostic Errors ‒ Error or delay in diagnosis ‒ Failure to employ indicated tests ‒ Error in collection of a specimen for diagnostic test ‒ Failure to act on results of monitoring or testing Diagnostic error can be defined as a diagnosis that is missed, wrong or delayed, as detected by some subsequent definitive test or finding. The ensuing harm results from the delay or failure to treat a condition which was present when the working diagnosis was wrong or unknown or from treatment provided for a condition not actually present. Failing to inform a patient of an abnormal outpatient diagnostic test result can be a serious error. Slide 37 5 Dimensions of Diagnostic Process ‒ Patient Related ‒ Patient-practitioner encounter ‒ Diagnostic test ‒ Follow-up & tracking ‒ Referrals Breakdowns were found to occur in all 5 dimensions of the diagnostic process, and in 43.7% of cases more than one dimension was involved. This chart illustrates the percentage of medical errors related to diagnostic process dimension. Most commonly, breakdowns occurred during the patient-practitioner clinical encounter (78.9%). Breakdowns involving the patient practitioner clinical encounter were most often judged to be due to data gathering and synthesis problems (i.e., cognitive errors) related to the medical history (56.3%), physical examination (47.4%), ordering of diagnostic tests for further workup (57.4%), and failure to review previous documentation (15.3%). Two additional documentation-related problems are notable. First, no differential diagnosis was documented at the index visit in 81.1% of cases. Second, practitioners copied and pasted previous progress notes into the index visit note in 7.4% of cases; of these cases, copying and pasting mistakes were determined to contribute to more than one-third (35.7%) of errors. Outside the patient-practitioner encounter, process breakdowns also occurred in the areas of referrals, patient actions or inaction, follow-up and tracking of diagnostic information, and performance and interpretation of diagnostic tests. 29 It's a New Day in Public Health FDOH