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‘Silently Harmed’ in Iowa – Bare Essentials

Silently-Harmed-IowaThe Silently Harmed white papers recently published by nonprofit, Heartland Health Research Institute, reveal a largely unknown problem in Iowa and nationwide. It is the number of patients seriously- and fatally-harmed in hospitals due to medical errors, also known as preventable adverse events (PAEs).

In addition to the state of Iowa, Silently Harmed provides estimated ranges of PAEs for a number of critical metrics in each of Iowa’s six neighboring states: Illinois, Minnesota, Missouri, Nebraska, South Dakota and Wisconsin. The difference between patients seriously- or fatally-harmed in each of the seven ‘Heartland’ states – as estimated in Silently Harmed – is a reflection of the number of inpatient admissions reported for each state – a metric primarily driven by state population.

Let’s review the highlights from Silently Harmed in Iowa.

Digging in-slide 1 (2)In 2012, hospitals in the United States had 34.8 million admissions, while during that same year, Iowa hospitals had about one percent of that number, or 340,000 admissions. It is important to note that Silently Harmed did not provide estimates for outpatient settings, such as doctors’ offices, nursing homes, outpatient surgeries, etc.

The annual estimated number of patients seriously- and fatally-harmed in U.S. hospitals due to PAEs is nothing short of staggering. Because PAEs go largely underreported or unreported, the national estimations vary wildly – primarily because the referenced national studies use a variety of research assumptions and methods that reach disparate conclusions that may or may not relate to each individual state. The slide below provides low- and high-end estimates for patients seriously- and fatally-harmed within U.S. hospitals.

Digging Deep Down

Seriously Harmed
From national estimates, HHRI extrapolated that as few as 64,500 patients are harmed in Iowa hospitals due to PAEs, with a high-end of 112,200 patients. The mid-range estimate of 85,000 patients are harmed in Iowa hospitals due to medical errors – enough to fill BOTH Kinnick Stadium and the Hilton Coliseum. Assuming the mid-range estimate is true, one patient is harmed every six minutes, or one in every four hospital admissions. In just one week, over 1,630 patients are harmed.

Seriously Harmed in Iowa

Fatally Harmed
Extrapolating from national estimated fatalities, annual Iowa fatalities from PAEs are 960 at the low-end, with 4,300 fatalities at the high-end. The mid-range estimate of 2,440 fatalities would mean that one fatality occurs every four hours, or one in every 139 admissions. Put another way, almost seven patients die from PAEs for every vehicle death in Iowa. For every murder in Iowa, 57 die from medical errors.

Fatally Harmed in Iowa

Social Cost of Mistakes
According to the Robert Wood Johnson Foundation, poor quality of care costs employers between $1,900 – $2,250 per employee per year, or about one-third of the single-employer premium in Iowa. The social cost of medical mistakes is massive. Social cost is determined by the “value of a statistical life,” a term used by economists. The estimated social cost for injuries due to medical mistakes can range from $909 million to $1.6 billion annually – just in Iowa. For fatally-harmed patients, the social cost ranges from $5.3 billion to almost $24 billion annually.

Social Cost of Mistakes

The estimated numbers provided in this particular post, in addition to the specifics on how these numbers were determined, are found in our free white paper, Silently Harmed: Hospital Medical Errors in Iowa.

Since the release of the Silently Harmed white papers, a number of employers have inquired about how their role must evolve to influence patient safety practices in the hospitals that serve their communities. We will address the employer role regarding patient safety issues in an upcoming blog.

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  1. Thank you for using my estimate of 440,000 deaths occurring prematurely from preventable events in hospitals. I published my estimate in the Journal of Patient Safety in 2013. I hasten to point out that the IOM estimate (up to 98,000) was from very old data (1984) and a time when errors of omission we unrecognized, and hospital-acquired infections were considered the cost of doing hospital business. Both of these are included in my estimate. In addition, I used a study from 2008 to estimate harms and death from mistakes that were missing from medical records. Thank you for drawing attention to the issue of harm in hospitals. We can do better.

    • David Lind says

      John, thank you very much for commenting on this blog. Your article in the ‘Journal of Patient Safety’ is so important in today’s discussion about PAEs and the progress we must make for improvement. In fact, your data serves a big part in the ‘Silently Harmed’ white papers and justly attributed to your work. Thank you again for your wonderful contribution to this critical topic.

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