4 Most Common Medical Errors in U.S. Hospitals

Medical error is the leading cause of accidental death in the United States. More Americans die from medical errors than from car accidents, plane crashes, drowning, and all other accidents combined.

In fact, medical error is the third leading cause of death in the U.S., after heart disease and cancer.

That’s unacceptable. Understanding the most common medical errors – and why they’re still so common, despite decades of effort – is a necessary first step toward improving patient safety.

According to the NEJM study, the four most common types of medical errors and adverse events in the United States are:

1. Medication Errors

The U.S. Food and Drug Administration (FDA) receives more than 100,000 reports annually of suspected medication errors. The actual number of med-related errors is likely much higher, as many drug errors are still not reported due to fear, embarrassment, lack of detection, and inefficient reporting systems, among other barriers.

One reason for continued high rates of medication errors: there are simply more drugs available today. More meds, including many that must be precisely administered to avoid dangerous side effects, equals more opportunity for mistakes.

Another factor that may be increasing medication errors: workforce shortages. Electronic medication systems and barcode medication administration systems (which verify patient identity and medication before releasing the proper drug) can decrease errors, but only when used as directed. Sadly, work-arounds “remain a pervasive issue,” with healthcare providers employing work-arounds “to save time.”

That’s what happened in the RaDonda Vought case: the Tennessee nurse used an override to access a dose of medication for a critically ill patient headed for a PET scan – and accidentally grabbed and administered vecuronium, a paralyzing anesthetic, instead of Versed, an anti-anxiety drug. The patient died.

2. Surgical or procedural events

Surgical or procedural event-related errors include “wrong-site, wrong-procedure, wrong-patient errors,” such as spinal surgery conducted on the wrong level of the spine. Mistakenly leaving surgical tools or material in a patient post-procedure is another example of a surgery or procedure-related medical error.

According to a 2015 study, there are at least 4000 surgical errors in the U.S. each year. However, there may be significantly more, as many studies of surgical errors only analyze procedures performed in operating rooms – and significant errors can (and do) occur in interventional radiology suites and procedure rooms as well.

Poor communication is often an underlying cause of surgical and procedural events. Preventing surgical and procedural events depends on “the combination of system solutions, strong teamwork and safety culture, and individual vigilance,” according to the Agency for Healthcare Research and Quality (AHRQ).

3. Patient-care events, including falls and pressure injuries

The recent NEJM article defined patient-care events “as an event related to nursing care, including falls and pressure ulcers.” These medical errors are directly impacted by nursing care, though patients’ underlying health conditions, prescribed medications, nutrition, and environment also play a role in these events.

Patient falls remain one of the most common adverse events reported in hospitals. Approximately 2-3% of patients fall during their hospital stays, with 1 in 4 falls resulting in injury. Pressure injuries, which can range from inflamed and irritated skin to deep ulcers stretching down to the bone, also remain common. Approximately 60,000 patients in the United States die as a direct result of a pressure injury each year.

Excellent, evidence-based nursing care can decrease the incidence of these common adverse events. Hourly nurse rounding, for instance, is an AHRQ Best Practice in Fall Prevention that has been linked with a 52% reduction in patient falls and 14% decrease in skin breakdown and pressure injuries.

4. Healthcare-associated infections (HAIs)

HAIs accounted for “only about 12%” of the adverse events noted in the NEJM article. The authors note that’s “a significant decrease from a 1991 study that found infections were the second-most-common adverse event.”

One huge caveat: The NEJM study is based on 2018 data. The COVID-19 pandemic seems to have erased much of the progress made toward reducing HAIs. Central-line associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), and ventilator-associated events (VAEs), including ventilator-associated pneumonia, all increased significantly in 2020 and 2021 (the last year for which data is available).

Effective hand hygiene remains the “single more important practice to prevent and control” healthcare-associated infections, according to the World Health Organization.

Decreasing medical errors requires system-based solutions. Technology that supports busy nurses, encourages appropriate hand hygiene, and facilitates proven safety interventions, such as hourly rounding and bedside shift report, can help.