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Nearly half of ear, nose, throat specialists experience errors

Patient Safety Monitor Alert, August 13, 2004

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Nearly half of ear, nose, and throat specialists say that a medical error occurred in their practice during the past six months, and that more than 40% of those errors caused major injuries or death, according to a study published in the August 2004 journal Laryngoscope.

Researchers at Boston's Children's Hospital, Tufts University School of Medicine, and Helsinki University Central Hospital in Finland randomly mailed an anonymous survey to 2,500 of their colleagues. They asked respondents whether an error had occurred in their practice in the last six months, and, if so, to describe the error, its consequences, and any corrective action taken.

About 45% of the 466 respondents said they did know of an error. About 78 of the 216 mistakes (36%) they recalled had resulted in major harm. Nine of the errors (4%) resulted in death.

The errors occurred in all phases of patient care, although most were related to technical causes (19%), medical management (14%), testing (10%), surgical planning (10%), medical equipment (9%), or wrong-site surgery.

Other errors were related to the history and physical, a differential or final diagnosis, a wrong drug or dilution on the surgical field , and communication.

Some of the results surprised researchers. Surgeons, for example, reported that at least seven patients were injured during endoscopic sinus surgery, including two who were blinded.

"I've never seen anyone lose their sight before, but two in the last six months, my God," David Roberson, MD, a surgeon at Children's Hospital and a co-author of the study, told the Boston Herald.

"The take-home message to doctors is that they need to ask and get information about errors and adverse events specific to their practice," Roberson added.

About 55% of those surveyed said they hadn't encountered an error in the last six months. Because younger physicians (under age 50) were more likely to report mistakes than older physicians, the researchers wondered whether all physicians are adequately trained to identify mistakes.

"Surgeons need to be...educated to see small errors as learning opportunities, rather than wait for a patient injury to address a problem,'' they wrote.

The Institute of Medicine estimates that one million patients are injured each year and that 98,000 die due to medical errors.

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