Can Case-Sharing Reduce Preventable Medical Errors?

Over the past few years, the medical and legal communities have been searching for ways to reduce the occurrence of preventable medical errors.  An April 2018 article published on MedPage Today suggests that case-sharing may reduce some preventable medical errors, but not all.  Still, new case-sharing and cross-checking methods offer one more possible way to reduce errors and promote a safer medical environment.

Read on to learn more about how case-sharing and cross-checking could help protect patients from preventable adverse events.  If you have questions about your legal rights as a patient, and what healthcare providers are required to do to prevent medical errors, contact the medical malpractice attorneys at MedMalFirm.com to find out more about your specific situation.

Case-Sharing and Cross-Checking

A cluster randomized trial held across six emergency departments in France revealed that cross-checks among emergency physicians reduced the number of some types of medical error.  The study, called CHARMED, instructed emergency departments to conduct cross-checks three times each day.  During the cross-checks, physicians presented their patient cases to one another, allowing for review and feedback.

The study utilized data from 1,680 patients, of which 68 percent were included in the cross-check period.  It was conducted over a period of four weeks divided into two individual two-week periods with a period of one month separating them.  During the cross-check intervention, emergency physicians were called upon three times each day to meet with their peers to discuss current patients.  Each meeting took an average of nine minutes.

The CHARMED study revealed the following about near miss or serious adverse events (preventable and otherwise):

• During the cross-check period, medical errors affected 6.4 percent of patients
• Outside the cross-check period, medical errors affected 10.7 percent of patients
• Near miss medical errors occurred in 3.1 percent of patients during the cross-check period
• Near miss medical errors occurred in 5.8 percent of patients outside the cross-check period
• Specific to preventable serious adverse events, there was no statistical significance

Like most research, this study was not without limitations.  The authors noted that the study was retrospective, so it could not take into account the factors that led to the error, or the extent of the error.  The authors further noted that there were difficulties in getting adequate time to utilize cross-checks in the emergency department since many patients were seen and released before a cross-check could be initiated.  Other possible caveats to the study included:

• Informal cross-checking may have occurred during the intervention phase without researcher knowledge.
• CHARMED did not take into account which physicians were working which days or shifts, which could cause imbalances due to certain physicians having a higher error rate than others.
• CHARMED did not track patients who may have experienced a medical error but then went to another hospital also participating in the study.
• Overall, the study was “underpowered” to adequately identify the effect of case-sharing and cross-checking on preventable adverse events on a significant level.

Most all research has limitations, and the CHARMED study is no exception.  What it does provide, however, is a glimmer of hope that something as simple as cross-checking on a regular basis could help prevent medical errors and improve overall quality and safety of medical care.

What Patients Need to Know about Medical Errors

In 2016, Johns Hopkins researchers calculated that over 250,000 Americans die every year due to medical errors.  Also in 2016, the U.S.  Centers for Disease Control and Prevention (CDC) listed medical errors as the third leading cause of death in the U.S., falling just behind heart disease and cancer.  Since these reports, researchers and patient advocates have worked tirelessly to bring awareness to the issue of medical errors, to educate and empower patients, and to place more accountability on healthcare providers.

In terms of awareness and education, many sources have since published helpful information about medical errors.  In April 2016, Consumer Reports published an article detailing five of the most common medical errors that occur in hospitals, which are:

1. Falls: If you are in the hospital, you are likely weak, may be hooked up to machines, and probably require assistance moving around or going to the restroom. It is the responsibility of healthcare providers to make sure you understand the risks, and know how to get help when needed.  Unfortunately, around one million people fall during hospitalization each year.  These falls cause broken bones, bruising, internal bleeding, and sometimes death.
2. Improper Antibiotic Use: More than half of all patients hospitalized are given antibiotics, but research by the CDC suggests that as many as 50 percent of these patients don’t need antibiotics or are given the wrong one. Using the incorrect antibiotic, or an antibiotic when not needed can kill good bacteria in your body, or predispose you to certain infections.  Every year, 250,000 people develop clostridium difficile (C. diff) infections as a result of antibiotic use.  Around 14,000 of those patients die from the infection.
3. Medication Errors: One of the most serious medical errors that occur in hospitals is medication errors. These errors occur when a patient is given the wrong medication, the wrong dosage, a medication that is not needed, or the medication is administered improperly.  According to researchers at Harvard, around 1,000 preventable medication errors occur every day in U.S.
4. Too Much Rest: You read that right. If you are in the hospital, it is possible to get too much rest.  Whenever you are ill or injured, as you heal it is important to start moving around as soon as you are able.  This helps keep your body strong, and circulates blood.  Too much rest or immobilization can lead to weakness, falls, and an increased risk of developing bedsores.
5. Chaotic Discharge: Some estimates suggest that one in five patients are readmitted to the hospital within 30 of being discharged. While sometimes that is unavoidable, often times it is because the patient developed an infection that did not present symptoms until they returned home.  In other cases, the patient may be discharged too soon, or without a proper diagnosis and treatment plan.

Reviewing some of the most common medical errors, it is easy to understand why studies like CHARMED would explore the important role of physicians and second opinions.

Have Questions about Medical Errors and Your Health?

If you are concerned about medical errors and your health, contact MedMalFirm.com to learn more about your legal rights.  As a patient, you have the right to quality, safe, and effective healthcare.  If you believe that you or a loved one has received care that was substandard or negligent, contact us today to speak with one of our medical malpractice attorneys.  Fill out our online form to get started!