Medical error the 3rd leading cause of death among Americans, researchers say

Medical error is the third leading cause of death in the United States, a Johns Hopkins study has found, even though they often go unreported.

These errors cause 250,000 deaths per year, falling behind cancer and the number one killer, heart disease, according to Johns Hopkins' researchers Martin Makary and Michael Daniel in the report published Tuesday in the medical journal, The BMJ.

The figure surpasses that of the third largest cause of death listed by the Centers for Disease Control and Prevention,  respiratory disease, they said.

However, medical error as a cause of death goes largely unreported because in filling out the death certificates, physicians, funeral directors, medical examiners and coroners rely on ICD-10 codes, and previously, ICD-9 codes.

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Causes of death due to human and system factors are not associated with an ICD code, the authors said.

Instead of simply requiring a cause of death, death certificates could contain an extra field asking whether a preventable complication stemming from the patient's medical care contributed to the death, the authors said in the Hub, a Johns Hopkins newsletter.

Currently, deaths caused by errors are unmeasured and discussions about prevention occur confidentially, such as during a hospital's internal root cause analysis committee or a department's morbidity and mortality conference. The authors are calling for more transparency.

Because the current system uses International Classification of Diseases billing codes to tally causes of death, funding for national research goes to the top-ranked causes of death, but not to medical errors, they said.

[Also: Costly, and often deadly, medical errors prompt calls for hospitals to accept fault]

The researchers, however, do not advocate for punishment or legal action.

"Incidence rates for deaths directly attributable to medical care gone awry haven't been recognized in any standardized method for collecting national statistics," Makary said. "The medical coding system was designed to maximize billing for physician services, not to collect national health statistics, as it is currently being used."

The errors are mostly preventable, according to the study, stemming from communication breakdowns, diagnostic errors, poor judgment, and inadequate skill. Most represent systemic problems, including poorly coordinated care, fragmented insurance networks, the absence or underuse of safety nets and unwarranted variation in physician practice patterns that lack accountability, the authors said.

[Also: Hundreds of hospitals score top marks as Leapfrog gives out safety grades]

Strategies to reduce death from medical care include making errors more visible when they occur; having remedies at hand to rescue patients; and following principles that take human limitations into account, the authors said.

For the study Makary and Daniel looked at medical death rate data over an eight-year period.

An examination of the health records of hospital inpatients in 2008, reported 180,000 deaths due to medical error a year among Medicare beneficiaries alone, according to the study's figures from the U.S. Department of Health and Human Services Office of the Inspector General. If the described rate of 1.13 percent is applied to all hospital admissions in 2013, it translates to over 400,000 deaths a year, the study said.

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The researchers examined four separate studies that analyzed medical death rate data from 2000 to 2008. Using hospital admission rates from 2013, they found that based on a total of 35.4 million hospitalizations, 251,454 deaths stemmed from a medical error, which the researchers say now translates to 9.5 percent of all deaths each year in the country.

Makary is a professor of surgery at the Johns Hopkins University School of Medicine and is the author of "Unaccountable," a book about transparency in healthcare.

Danielis the Rodda patient safety research fellow at Johns Hopkins and is focused on health services research.

The article arose from discussions about the lack of funding available to support quality and safety research relative to other causes of death.

Twitter: @SusanJMorse