Graham Center One-Pager

Consequences of Medical Errors Observed by Family Physicians

In two studies about medical errors, family physicians reported health, time, and financial consequences in nearly 85 percent of their error reports. Health consequences occurred when the error caused pain, extended or created illness, or placed patients, their families, and others at greater risk of harm. Care consequences included delayed diagnosis and treatment (sometimes of serious health conditions such as cancer), and disruptions to care that sometimes even resulted in patients needing care in a hospital. Other important consequences were financial and time costs to patients, health care providers, and the health system generally. However, sometimes no consequence was apparent.

The studies used a broad definition of "error" that made sure any error could be included, regardless of whether it could cause harm to patients. The definition deliberately related to any error or mistake rather than to "preventable adverse events" or "sentinel events." Family physicians were encouraged to report devastating and apparently trivial events, because even common mishaps not usually regarded as important medical errors might sometimes have devastating consequences. The accompanying table shows the number (and percentage) of reports that included at least one consequence. Consequences more often were revealed by qualitative analysis of the story told in each report than by family physicians' responses to direct questioning. Each case may be associated with more than one consequence, but in 120 reports, no consequence was recorded or implied.

These data suggest that in comparison with their international colleagues, U.S. family physicians may choose more often to report medical errors that do not hurt their patients physically but do create extra financial burdens. Every error type previously reported--medication errors, laboratory and diagnostic imaging errors, administration and information management errors, even filing mistakes--did sometimes harm patients, place patients at risk of harm, or add unnecessary costs to their care. Moreover, all errors impacted health care providers, making the work of physicians, pharmacists, nurses, and others involved in health care less efficient, more time-consuming, and more wasteful of money than it could be.

Reducing the incidence of medical errors observed by family physicians will improve patients' safety and health status, and reduce health care costs.

Consequences of Medical Errors Reported by Family Physicians in the United States and Five Other Countries Consequence U.S. family physicians' reports (n = 416) Family physicians' reports from five other countries (n = 356) Total (n = 772) None reported 79 (19%) 41 (11.5%) 120 (15.5%) Health consequences, including 156 (37.5%) 206 (57.9%) 362 (46.9%)   Patient/others at increased risk* 88 (21.2%) 85 (23.9%) 173 (22.4%)   Patient upset 21 (5%) 33 (9.3%) 54 (7%)   Patient suffered physical pain 13 (3.1%) 36 (10.1%) 49 (6.3%)   Patient's health status worsened 41 (9.9%) 93 (26.1%) 134 (17.4%) Care consequences, including 146 (35.1%) 155 (43.5%) 301 (39%)   Care delayed 83 (20%) 81 (22.8%) 164 (21.2%)   Patient admitted to the hospital 10 (2.4%) 12 (3.4%) 22 (2.8%) Financial and time costs, including costs to 90 (21.6%) 64 (18%) 154 (19.9%)   Patients 65 (15.6%) 36 (10.1%) 101 (13.1%)   Physicians, pharmacists, staff 81 (19.5%) 45 (12.6%) 126 (16.3%)   Health system/payers 36 (8.7%) 31 (8.7%) 67 (8.7%) *--No actual harm occurred in these cases, but the medical error unnecessarily placed patients in the position where harm was a real possibility.

Adapted from Graham Center One-Pager #17. Dovey SM, Phillips RL, Green LA, Fryer GE. Consequences of medical errors observed by family physicians. January 2003. Available at: www.aafppolicy.org/x395.xml. From the Robert Graham Center: Policy Studies in Family Practice and Primary Care, 1350 Connecticut Ave., NW, Suite 950, Washington, DC 20036 (telephone: 202-986-5708; fax: 202-986-7034; e-mail: policy@aafp.org).