Deadly 7 Hospital Mistakes

Hospitals manufacture miracles by the millions. They can also be hazardous to your health.

According to The Institute of Medicine, a non-profit organization chartered by the U.S. National Academy of Sciences, at least 1.5 million Americans fall prey to hospital error every year.

"Errors will happen anytime you take a complex system and put human beings inside of it," says Dr. Brent James, vice president of medical research and executive director of Salt Lake City's Intermountain Institute for Health Care Delivery Research. "The notion that you can train doctors to completely avoid mistakes is just false." In Pictures: The Seven Scariest Hospital Complications

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The mistakes aren't exactly minor, either. Between 40,000 and 100,000 people die every year because of shoddy handiwork, including surgical mishaps and drug mix-ups. One big problem: Hospital patients may get the wrong drug one time out of five, according to a study by Auburn University. The death toll from mistakes is at least as bad as that from car accidents or breast cancer, and maybe as bad as that from strokes.

Another 100,000 people die because of infections from hospital-bred bacteria that are resistant to one or more of the antibiotics doctors use to kill them off, according to the Center for Disease Control. Some of those might be prevented by more hand washing or other precautions.

No patient, rich or poor, is immune to hospital risk. Back in November, actor Dennis Quaid's newborn twins were given 1,000 times the intended dosage of heparin (a blood thinner) just after their birth at Cedar Sinai Medical Center in Los Angeles. The twins' blood became dangerously thin, making them prone to hemorrhaging. Hospital staff detected the error and the children were given a second drug to counteract the heparin.

In another widely reported case, comedian Dana Carvey was the victim of a botched heart bypass operation; his doctor operated on the wrong artery. The problem was fixed in a second procedure.

Managing these risks often comes down to unrelenting attention to detail. One study showed doctors only washed their hands 44% of the time if nobody was looking. If they knew they were being watched, 61% washed up--still way too low.

At least the hospitals are making better ground on pneumonia. Born of bacteria that collect and live in ventilator machines that keep patients breathing, these potential killers were once accepted as a cost of doing business, but today hyper-vigilant hospitals can go months or years between cases. Germ-fighting fixes include inclining patients' beds, disinfecting their mouths and using drugs to prevent ulcers that could cause stomach bacteria to infiltrate the lungs.

But even extreme vigilance can't cope with the hospital system's core problem: overcrowding.

"Doctors and nurses spend insufficient time with each patient," says Evan Falchuk, president of Boston-based Best Doctors, which works with insurers and employers to help the very sick navigate the health care system. "Many doctors are seeing between 30 and 40 patients per day."

With more patients than resources to treat them, hospitals often end up putting people in the wrong departments--with nurses and aids who aren't trained to treat their illnesses. Shuffling patients from different wings invites the spread of airborne infections, too.

Reducing the overcrowding has become the quest of Eugene Litvak, a researcher at Boston University who helped telecommunications companies work more efficiently in his native Russia before moving to the U.S. Litvak says that the solution to the rampant overcrowding is smoothing the massive volatility in patient care.

The challenge is similar to preventing traffic jams. It's not so much that there aren't enough doctors and nurses, but that patients tend to show up all at once or not at all. And traffic spikes don't occur because of kids falling out of trees or sudden epidemics; it's that surgeons are allowed to schedule operations without regard for how many operating rooms will work at the same time. Badly scheduled admissions, says Litvak, "will screw up everything else that you build."

At Boston University Medical Center, Litvak reduced the number of surgeries that needed to be rescheduled in a year to seven from 700. At Cincinnati Children's Hospital, he increased the number of surgeries conducted by evening out the flow; at the same time, the number of nasty complications like ventilator pneumonia and surgical errors went down.

Unfortunately, though, patients don't have control of how operations are scheduled. Best Doctors' Falchuk says to be your own advocate. "[People] want someone to wave a wand and fix the problem," says Falchuk. "If you're sick, the best way to avoid getting sicker is to take charge of your care."

Risk: Surgeon error Prevention: A quick conversation

Surgery foul-ups run the gamut--from freakish incidents involving scalpels left inside patients and wrong limbs being amputated to excessive bleeding and sudden heart failure. That's why the entire surgical team--the surgeon, the anesthesiologist and the nurses--should pause to discuss the case together before a single cut is made.

Risk: Infected incisions Prevention: Antibiotics before surgery

Infected incisions are particularly dangerous as hospital germs are more likely to be resistant to antibiotics that doctors use to kill them off. Antibiotics before the operation can do wonders, though they don't work if administered too late.

Risk: Bleeding too much Prevention: Active medication management

Bleeding is a big risk--both during surgery and after due to blood-thinning drugs--and is one of the hardest problems to combat. Anticoagulants like heparin, an injection given during operations, and Coumadin, a pill, can help, but getting the dose right is critical. Coumadin requires frequent testing of blood levels, and often hospital patients are less well controlled than they would be at home. Make sure doctors get lab tests with a history of past readings, rather than an isolated number.

Risk: Getting sicker Prevention: Continuous vigilance

While patients often have a good sense of how they feel when managing their illness at home, their perception gets clouded in the hospital--and that leads to complications. Example: Patients with adult diabetes have to take drugs, including various preparations of insulin, to keep their blood sugar from getting too high. Too much sugar in the blood can damage blood vessels in the kidneys, heart and eyes. To prevent problems, blood-sugar readings should be monitored as a list of numbers (as opposed to a single value) to detect important changes.

Risk: Pneumonia Prevention: Better ventilator care

Patients on ventilators are already very sick, but an infected ventilator can make matters worse. Ventilators are breeding ground for germs if water pools in its hoses; bacteria can move from the stomach into the lungs through the machine. The most proven fixes include keeping patients propped up, so gravity works against the germs, and not keeping patients constantly sedated; others include new machines that heat ventilator tubing to keep water from pooling

Risk: Infected catheter Prevention: Stay clean

Some of the most serious hospital infections occur when germs get into central lines--special catheters placed in the chest to deliver medicines more quickly and easily. Medical staff should wear gloves, masks and other barriers to infection; use the correct disinfectants; and watch for signs of sepsis, a dangerous immune response to a bloodstream infection.

Risk: Getting the wrong medicine Prevention: Prescription by computer

Hospital patients may get the wrong drug one time out of five, according to a study by Auburn University. One of the most important fixes being implemented across the country: throwing out the prescribing pad, and with it, messy doctor handwriting. Older systems rely on computers by the bedside; newer ones can use wireless tablets or handheld computers. Some use bar codes on patients' wrists and drug vials to make sure the right medicine is getting to the right person.