The Institute of Medicine has identified medical error as a leading cause of death
and injury, with deaths resulting from medical error exceeding those caused by motor
vehicle collisions, breast cancer, or AIDS. The authors examined the incidence and
sources of medical error in relation to adverse events on a pediatric general surgery
service.
All intensive care unit (ICU) and ward admissions to 2 staff pediatric general surgeons
during a 1-month period were identified prospectively and in-patient care was reviewed
daily by a 3-person panel consisting of a staff surgeon, a surgical fellow, and a
nonmedical observer. Medical errors, identified through daily patient encounters,
nursing rounds, medical rounds, and chart examinations, were evaluated based on type,
hospital setting, personnel involved, and outcome. Adverse outcomes were evaluated
based on type and contributing factors.
Our study group included 64 patients. A total of 108 errors were identified; 28% of
these errors resulted in adverse outcomes. One or more medical errors were identified
in the care of two thirds of patients (43 of 64), with medical error contributing
to adverse outcomes in one third of patients (21 of 64). Errors occurred most frequently
in communication, postoperative monitoring and care, and diagnosis, with errors in
postoperative care and diagnosis having the highest likelihood of resulting in an
adverse outcome. Seventy-four adverse outcomes were identified in 31 patients; 35
(47%) of these outcomes, occurring in 21 patients, were attributable to medical error.
The most common adverse outcomes identified were additional nonoperative procedures,
of which, 92% resulted from medical error. There were no deaths.
Medical error occurs in more than one half of hospital admissions on a general pediatric
surgery service and contributes to a substantial number of adverse outcomes.