Photo by Sean Gallup/Getty Images

How to avoid medical mistakes

Kathryn McDonald, the Executive Director of the Center for Health Policy/Primary Care and Outcomes Research, talks with Nicole Feldman.

You made it through your first heart attack, but now you need to have a pacemaker put in. Naturally, you’re nervous; the doctor has gone over the many things that could go wrong in excruciating detail. But even he couldn’t predict what actually happens. The procedure goes well…until the surgeon slips and accidentally punctures your lung.

These types of mishaps don’t happen often, but they do happen. Before systems were put in place to protect patient safety, they happened more often. Stanford Health Policy’s Kathryn McDonald tells us how we keep patients safe and how to maintain high-quality health care.

Why should we care about patient safety? Are we in danger?

When I started out in this area, I was rather naive and didn’t know all of the things that could go wrong. About 15 years ago, a major report showed that the number of deaths due to potentially preventable harm that came through the health-care system was near 100,000 per year. That’s the equivalent of a jumbo jet going down everyday. That made it a national priority.

What kinds of things happen that we don’t know about?

There’s actually a lot of different types of harms that can happen. Each harm isn’t happening that frequently, and that’s the real challenge. There aren’t very many times that say, a foreign object — like a sponge — is left inside a body during surgery, but it was happening. We think that it shouldn’t happen at all. Now the health-care systems, the delivery systems, the operating rooms have come up with strategies to reduce the chance of that.

How can we improve the quality of health care?

One of the lead agencies that’s responsible for generating evidence and moving it into practice is the Agency for Healthcare Research and Quality (AHRQ). They’re under Health and Human Services. They have a major program called AHRQ’s Evidence Now aimed at improving heart health in America. Lots of people are on aspirin to prevent heart attacks, but there are also lots of people who could benefit from it who aren’t on it. They’re working with the health-care delivery system to figure out how to get patients who need to be on aspirin to use it. These are driven by reforms to make the delivery system accountable for patients’ health. If you can change behavior — either of patients or of physicians — you can save more lives.

How can policy make patients safer?

Policy can push for and incentivize figuring out how to promote behaviors. We could do a lot better if we had a great set of measures. What do all patients want? They don’t want to be harmed. They don’t want to have their quality of life affected when it doesn’t have to be. If we can measure what all people see as the ideal, and make sure we’re getting constant feedback, then we would make more progress. The good news is that in efforts like AHRQ’s and in Medicare and Medicaid, there is evidence to show that from 2010 to 2015 more than 3 million hospital-acquired infections were prevented, and the associated savings from averting those conditions have been estimated to be almost $30 billion.