Everyone needs medical care at some point. And no one wants their healthcare to make them sicker. However, there are some common, potentially dangerous patient safety risks you should know about.
This post, and its companion post, are based on information provided by ECRI, a nonprofit organization dedicated to improving the safety, quality, and cost-effectiveness of care across all healthcare settings.
Although ECRI’s focus is on helping healthcare facilities improve safety issues, I think it’s important for patients and families to understand these risks as well. Knowledge is power. Fortunately, for many of these patient safety concerns, there are steps you can take to reduce the risks for yourself or a loved one.
As part of their mission to improve healthcare, each year, ECRI identifies risks to patients using reports of millions of healthcare events that caused patient harm. For this post, I referenced these reports:
- 2023 Top 10 Patient Safety Concerns.
- 2022 Top Health Technology Hazards.
- 2020 Top Patient Safety Concerns.
- 2020 Top Health Technology Hazards.
- 2019 Top Health Technology Hazards.
This post covers the following patient safety risks:
- Missed and delayed diagnoses.
- Harm from medical devices.
- Patient matching discrepancies in Electronic Health Records.
- Improper use of antibiotics.
- Fragmentation of care.
- Harm from MRI scans due to missing information about patient implants.
- Central venous catheter in at-home hemodialysis.
- Delayed identification and treatment of sepsis.
The next post in this series covers these patient safety risks:
- Alarm, alert, and notification overload.
- Contaminated devices and tools.
- Surgical sponges left in patients.
- Surgical stapler hazards.
- Unproven surgical robotic procedures.
- Discrepancies in EHRs can cause medication timing errors.
- Overrides of automated dispensing cabinets can cause medication errors.
- Confusing dose rate with flow rate can lead to infusion pump medication errors.
- Damaged infusion pumps can cause medication errors.
- Mattresses oozing bodily fluids.
Note: These patient safety risks are not in any particular order.
Missed and delayed diagnoses.
When a diagnosis is missed or delayed, you likely won’t receive needed treatments in a timely manner. Without appropriate treatment, conditions can worsen, which can increase suffering and lead to worse outcomes, including permanent damage or death.
How common are diagnostic errors?
Research shows diagnostic error rates of diagnostic error rates of 10-15%, causing about causing about 10% of patient deaths. An estimated 12 million Americans experience a diagnostic error in primary care settings each year.
Why do doctors make diagnostic mistakes?
Diagnosing an illness can be tricky because doctors must use their judgment and experience, along with test results, to determine possible causes of ailments. Importantly, medicine is part science, part art.
Additionally, every patient is different, and symptoms can vary. And many conditions have similar symptoms, making it easy to make a mistake. Moreover, as time passes and more information becomes available (through testing, etc.) the diagnosis can change.
Finally, time-squeezed appointments can make it hard for doctors to understand each patient’s relevant circumstances through a physical exam and an accurate history.
What can you do about diagnostic-related patient safety risks?
To reduce your risk of diagnostic errors, follow these steps:
- Research your symptoms before your appointment and make a list of possible diagnoses.
- Make a list of questions and ask each one.
- Be sure your doctor understands your “story”. And don’t let the doctor cut you short.
- When doctors ask yes/no questions, feel free to elaborate.
- If you don’t understand something your doctor tells you, ask him/her to repeat the information until you feel confident you understand.
- If your doctor’s diagnosis doesn’t make sense to you, tell him/her during or after the appointment.
- Don’t assume that “no news is good news”.
- Don’t assume each specialist on your team is communicating.
- If something doesn’t seem right, speak up.
- Get a 2nd opinion, or even 3rd opinion.
- If you feel your doctor doesn’t listen to you, try to find a new doctor.
For more detailed information, read 10 Steps to Reduce Your Risk of Diagnostic Error.
Harm from medical devices.
Medical devices help patients survive and thrive. But they can also cause harm when they fail.
How often do medical devices cause harm?
An investigation by the International Consortium of Investigative Journalists (ICIJ) found that in a recent 10 year period there were more than 1.7 million injuries from medical devices of all types. Moreover, there were almost 83,000 deaths in that time.
What can you do?
Before you agree to a medical device, ask your doctor these questions:
- Are there any steps you can take to avoid the device?
- Is it possible to remove the device if a problem develops?
- How long has the recommended device been on the market?
- Have there been clinical trials for this specific device? What do the results show?
- How many surgeries have you performed using this specific device? What were the outcomes for these patients?
Additionally, do some of your own research into the safety record of any recommended device. For more information, read How Safe are Medical Devices?
Patient matching discrepancies in Electronic Health Records.
Most hospitals and medical practices use Electronic Health Records (EHRs) and other digital technologies. Of course, when EHRs contain mistakes, patients can be harmed, or even killed. “Patient matching” involves having the right patient information in the right patient file.
However, EHRs can contain patient names that are either outright wrong, contain spelling errors or other mistaken patient identifiers. Additionally, one patient’s records can contain information related to another patient.
What is the impact of improper patient matching?
When there are matching errors, EHRs contain mistakes that can cause significant patient harm. For example, patients may receive the wrong medications or undergo unnecessary testing based on misinformation in their EHR. Conversely, they may miss medications and/or testing they need.
And, the danger is amplified when misinformation spreads throughout the entire health information exchange.
What can you do?
First, never assume your EHRs are accurate. Review your records through online portals whenever possible. And ask your doctor to print out appointment notes before you leave the office. Read them over and notify the office if you see mistakes. For more information, read How Common are Patient Identification Errors? and 6 Dangers of Electronic Health Records.
Improper use of antibiotics.
I’m sure you’ve heard this before – as a society, we take too many antibiotics, which puts us all at risk of dangerous antibiotic-resistant superbugs. Despite an increased focus on this issue, patients still take unnecessary antibiotics, including taking them when there is no indication, taking them longer than needed, or taking the wrong dosage.
How do patients get unnecessary antibiotics?
Sometimes, patients insist on getting a prescription for antibiotics, even if their doctors advise against it.
And unfortunately, sometimes doctors (and dentists) prescribe antibiotics when they’re not needed. For instance, researchers found that in 2014, 45.7% of urgent care patients received antibiotics for respiratory issues that did not require antibiotics.
Why is this a concern?
Antibiotics can cause patient harm, particularly in hospital patients. Moreover, the overuse of antibiotics has led to the rise of antibiotic-resistant superbugs that don’t respond to treatment.
In fact, some experts speculate that antibiotic-resistant superbugs may kill more people than cancer in the coming decades.
What can you do?
Do your part! Don’t insist on antibiotics. And if you do need them, take them as directed. For more detailed information, read this blog post: Are Antibiotics Helpful or Harmful? What You Need to Know.
Fragmentation of care.
When patients have more than one doctor treating them, it’s important for every doctor on the “team” to understand each patient’s history, diagnoses, testing, medications, treatments, etc. Fragmented care occurs when different healthcare providers and/or healthcare organizations do not work well together.
Unfortunately, seeing multiple doctors can lead to fragmented care, which can impede communication among providers and make the coordination of care very difficult.
What’s the impact of fragmented care?
Patients can suffer when healthcare is fragmented. Potential problems include hospital readmissions, missed or delayed diagnoses, medication errors, and unnecessary tests and procedures.
What makes care coordination issues more likely?
There are a few scenarios in which care is more likely to be fragmented. First, patients with multiple chronic condition may experience care coordination issues as they may visit up to 16 different doctors in a year. That’s a lot of care to be coordinated! With this many doctors involved, it’s easy to see how information can slip through the cracks.
Additionally, when patients receive care at urgent care centers and other retail clinics, the information is often not communicated with the patients’ primary care doctors, which can lead to gaps in care.
What can you do about patient safety risks related to fragmented care?
Primarily, never assume that each doctor on your team knows about the care you receive from other doctors. And don’t think your doctors coordinate your care because they all work in the same healthcare system. Care fragmentation can occur within one healthcare system or between several healthcare systems.
You must be the captain of your ship. Engage in the process!
Take detailed notes in a notebook at every appointment – including diagnoses, treatments, test results, and other important information. If a doctor recommends you see a specialist, write down your doctor’s specific reasons for the referral. Bring this notebook, along with any pertinent test information (e.g. MRI scans) with you to every appointment and share the material with each doctor.
And of course, if you visit a retail clinic or urgent care center, let your doctor know why you went and what diagnosis and treatment recommendations you received.
To learn more, read 10 Tips for a Better Medical Appointment.
Harm from MRI scans due to missing information about patient implants.
Many patients have implanted devices, such as pacemakers, artificial hips, insulin pumps, or dental implants. The strong magnets of an MRI can cause an implanted device to heat up, move or malfunction, potentially leading to patient harm.
To protect patients, MRI staff must know about implanted devices and follow steps for safe MRI screening prescribed by the manufacturer of the implant. However, MRI staff don’t always know about a patient’s implant(s), which can cause a dangerous situation.
Why is implant information hard for MRI staff to find?
Because electronic health records (EHRs) are not standardized, providers can enter specific information about a patient’s implant in a variety of places within a patient’s EHR. This lack of a consistent record keeping protocol makes it difficult for MRI staff to determine the type and location of any implants. And sometimes this information isn’t recorded anywhere!
Furthermore, asking patients for this information can be unreliable. Some patients don’t know the specific details about their own implants. And sometimes patients are too ill to respond.
What kinds of patient harm can result?
If an implant overheats, it can damage the surrounding soft tissue. Additionally, the MRI system can damage the implanted device, which can then malfunction and cause patient harm.
And postponing an MRI in order to research implant guidelines can delay diagnosis and treatment, which can also lead to patient harm.
What can you do?
Fortunately, there is an easy solution. Create a detailed record with the type, brand and model, as well as the location of any implant, including dental implants. Bring this with you to any MRI appointment and share it with staff.
And to be safe, keep the information on a piece of paper in your wallet – you never know when an unexpected incident, like a car accident, will land you in an MRI machine.
Central venous catheters in at-home hemodialysis.
For some patients with end stage renal disease, getting hemodialysis at home provides many long-term benefits. However, for patients receiving home hemodialysis through a central venous catheter (CVC), the risks of home dialysis might outweigh the benefits.
What is the potential danger of CVCs?
CVCs are usually placed through a large central vein, like the jugular vein, to provide a path from a point outside the patient’s body directly to the patient’s heart. Because of this direct pathway, issues such as infection, clotting, disconnection, and air embolism can cause severe health consequences for patients.
Home use of CVC increases the risk of serious health problems.
Family members and other caregivers may lack the training and experience needed to manage the risks of CVCs and/or to respond to a CVC related problem. In contrast, in a healthcare setting, the clinical staff can provide proper CVC care and properly address any problems.
What can you do?
If you receive home hemodialysis through a CVC, ask your doctor about switching to another form of vascular access.
Delayed identification and treatment of sepsis.
Sepsis, the body’s overwhelming response to infection, can lead to tissue damage, organ failure, and even death. Unfortunately, any infection can lead to sepsis.
Every year in the US, over 1.7 million adults develop sepsis. Sadly, it leads to death in about 30% of cases, making sepsis the leading cause of death in US hospitals.
Why is delayed identification and treatment so dangerous?
Starting antimicrobials within the first hour of recognizing a patient has septic shock is associated with a 79.9% survival rate. During the first six hours of sepsis, the survival rate decreases by 7.6 percentage points for each hour that antimicrobials are delayed.
Importantly, doctors must evaluate the potential harm of giving a patient unneeded antimicrobials, so accurate testing is vital.
What can you do to reduce your risk?
Learning more about infection prevention and control, sepsis warning signs, and what to do if you suspect sepsis, can reduce your risk of harm. Read Why is Sepsis Dangerous? for more information and tips.
NOTE: I updated this post on 3-27-23.