Are medical errors really the third most common cause of death in the U.S.? (2019 edition)

Simple questions: Is the 12% full recovery rate of tPA a medical error? What should ER doctors have done about that knowledge way back in 1996 when it was approved for use? 

Is every 30 day stroke death a medical error? Because your doctors and stroke hospitals never initiated any research to stop the 5 causes of the neuronal cascade of death in the first week?

 

Are medical errors really the third most common cause of death in the U.S.? (2019 edition)

There is a myth promulgated by both quacks and academics who should know better that medical errors are the third leading cause of death in the United States. You’ll see figures of 250,000 or even 400,000 deaths each year due to medical errors, which would indeed be the third leading cause of death after heart disease (635,000/year) and cancer (598,000/year). When last I discussed this issue three years ago, specifically a rather poor study out of The Johns Hopkins that estimated that 250,000 to 400,000 deaths per year are due to medical errors, I pointed out how these figures are vastly inflated and don’t even make any sense on the surface. For one thing, there are only 2.7 million total deaths per year in the US, which would mean that these estimates, if accurate, would translate into 9% to 15% of all deaths being due to medical errors. Those numbers just don’t make sense. It’s even worse than that, though. This particular study looked at hospital-based deaths, of which there are around 715,000 per year, which would imply that these estimates, if accurate, would mean that medical errors cause between 35% and 56% of all in-hospital deaths, numbers that are highly implausible, something that would be obvious if anyone ever bothered to look at the appropriate denominators. Unfortunately, in the three years since its publication, the Makary study has taken on a life of its own, and it’s basically become commonly accepted knowledge that medical errors are the third leading cause of death, even though this estimate is based on highly flawed studies and these numbers are five- to ten-fold greater than the number of people who die in auto collisions every year.

Yes, Arthur Allen, a writer I’ve admired since his book Vaccine, casually included that factoid in his story.
The attempt to quantify how many deaths are attributable to medical error began in earnest in 2000 with the Institute of Medicine’s To Err Is Human, which estimated that the death rate due to medical error was 44,000 to 96,000, roughly one to two times the death rate from automobiles. At the time, in response to the study, the quality improvement (QI) revolution began. Every hospital began implementing QI initiatives. Indeed, I was co-director of a statewide QI effort for breast cancer patients for three years. Yet, as Mark Hoofnagle points out in the Twitter thread above, the estimates for “death by medicine” keep increasing. They went from 100,000 to 200,000 and now as high as 400,000. On quack websites, the number is even higher. For instance, über-quack Gary Null teamed with Carolyn Dean, Martin Feldman, Debora Rasio, and Dorothy Smith to write a paper “Death by Medicine,” which estimated that the total number of iatrogenic deaths is nearly 800,000 a year, which would be the number one cause of death, if true and nearly one-third of all deaths in the US. Basically, when it comes to these estimates, it seems as though everyone is in a race to see who can blame the most deaths on medical errors.

Replying to @gorskon @ArthurAllen202

Damn @gorskon, I usually cite you.

But I can do a quick tweetorial of my critique.https://sciencebasedmedicine.org/are-medical-errors-really-the-third-most-common-cause-of-death-in-the-u-s/ …

Are medical errors really the third most common cause of death in the U.S.?

A regurgitation of existing data suggested that medical error is the third leading cause of death in America. Is it true? Spoiler alert! No. No it's not. While medical error can and should be...

sciencebasedmedicine.org

Mark Hoofnagle @MarkHoofnagle

Here's the history, the "3rd cause" canard comes from a major frameshift on measuring error, and a questionable algorithmic measurement of error that does not actually detect mistakes but "ripples" in the EMR that are *proxies* for error - ICU admissions, major order changes etc.

3

12:27 PM - Feb 1, 2019

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Moving beyond medical errors: How EHRs are 'nudging' practices to change certain behavior

A simple question: Is the 12% full recovery rate of tPA a medical error? What should ER doctors have done about that knowledge way back in 1996 when it was approved for use?

Moving beyond medical errors: How EHRs are 'nudging' practices to change certain behavior

Electronic health records (EHRs) are usually cited for their ability to help diagnose diseases and reduce medical errors. But several health systems are testing how EHRs can be used to target other factors, like patient comfort and drug shortages.
Since EHRs are frequently used to guide patient care, adjusting the output of those systems can have considerable impact on patients—beyond just their immediate health condition.
Consider the University of Chicago Medical Center, which has been experimenting with a study module called SIESTA (Sleep for Inpatients: Empowering Staff to Act) to help patients in hospitals sleep better. The study is aimed at reducing nighttime awakenings for inpatients so they don't experience in-hospital sleep deprivation.

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Inpatient sleep deprivation occurs when EHRs prompt doctors and nurses to take vital signs, administer medication or perform a test irrespective of the time of day. If a patient is being consistently woken up this way, they can suffer grogginess, delirium and falls.
“As a frequently hospitalized patient, I am used to being woken up as often as every one to two hours,” Sara Ringer, a hospital patient, told the University. “It never feels like your body has a chance to rest and heal. My last hospitalization at University of Chicago was one of the easiest I've had because the hospital staff made it possible for me to sleep.”

Alerting clinicians to potential problems—constantly

SIESTA works by adding alerts to the EHR, which remind healthcare workers they may want to delay disruptions that are minimally important (such as measuring vital signs). While it's certainly possible to simply provide training to clinicians to avoid nighttime awakenings, the researchers said the EHR reminders work better.
“Efforts to improve patients’ sleep are not new, but they do not often stick because they rely on staff to remember to implement the changes,” said the study’s lead author Vineet Arora, M.D., professor of medicine at the University of Chicago.
But alerts aren't always effective either because clinicians can start mentally blocking them out, said Raj Ratwani, M.D., director of the national center for human factors in healthcare at Medstar Health. When a physician gets an alert for something or other every few minutes (a suggestion to use a certain drug, a suggestion about when to perform a test, etc.), it stops being a concern and starts becoming an interruption of their workflow, according to Ratwani's research.

Ratwani pointed to an eye-tracking study done on residents completing certain tasks in an EHR. It found that after a time, physicians would by habit bring their cursor to the place on the screen ready to close an alert box after selecting certain options—before it had even popped up. They had become that inured to the reminders.
"Those are the kind of alerts that drive physicians nuts, because think about how many of those they get, how busy they are," Ratwani told FierceHealthcare in an interview. "What's happening is you just get used to it, it becomes an interruption of your workflow, and you just want to get past it."

Background UI changes—subtle and concerningly unnoticeable

Another approach to nudging clinicians' behavior is to change the EHR's user interface (UI) to cognitively disincentivize certain choices. Putting undesired options further down on a drop-down list, for instance, or graying them out, can cause clinicians to select them less often without interrupting workflow.
Many EHRs already do this to avoid negative health outcomes, like unintended drug interactions or dangerous opioid doses. But all those tools are available to nudge behavior for other reasons, Ratwani said. They can just as easily be employed to avoid a drug that's on shortage or out of range.
"Oftentimes what happens is providers get emails, and they'll get an email that says 'please don't prescribe medication A, prescribe medication B instead'. And then they're tasked with having to remember that information on top of all the other things they have to do. So that's a great instance where it would be far more effective to manipulate the interface a little bit to make it more difficult to order those medications that are on shortage," he said.
"Things that you want to prevent or push people away from—you want that to take more cognitive effort than you want people to actually use," Ratwani added. "So you're guiding them without them needing to do a lot of effort to acknowledge them or interrupt their workflow. And that's where it's most effective—where it's very passive and doesn't require a lot of effort on the part of the physician."
The trouble here is that the UI changes can tread into the territory of making decisions instead of clinicians. And while the grayed-out options should still be available to select in most cases, the psychological disincentive it provides is powerful, Ratwani said. One study showed that even a one- to two-second delay in the time that it takes to do something will push people away from that action most of the time.
Furthermore, it's not clear that the suggestions pushed by the UI will always be appropriate. It would be easy for a drug shortage to end, for instance, but not have the EHR update to reflect that until months later.
"There is tremendous potential for unintended consequences in this kind of change—to any interface. Just in the example of order sets, many have been updated but the clinician's not aware that it's been updated, so they may be operating under the previous conditions of that order set," Ratwani said. "This can be a big problem, and it's similar to the drug shortage scenario, where there is a change and it's not obvious."
Ultimately, no solution is perfect. Personal reminders are too forgettable, EHR reminders are too repetitive and easy to ignore, and UI changes are too difficult to notice and overrule.
So while EHR changes can be a powerful tool for hospitals and health systems to incentivize certain behavior, they will have to be vigilant about the unintended consequences.

The Necessity of Striving for Unattainable Goals

Not directly stroke related but it should be. The unattainable goal of 100% recovery for all will never occur under current stroke leadership. They all need to die. Too bad. They had their chance and totally blew it, don't feel sorry for them.

The Necessity of Striving for Unattainable Goals

We can't eliminate all errors. But we have to keep trying

• by Fred N. Pelzman, MD November 02, 2017

Walking into the office very early this morning, before the 8:00 seminar I was scheduled to give for the interns on ambulatory block rotation, I happened to look up and notice this safety cone, which stays curled up in a gray plastic container on the wall of our practice, right where it has been for quite a few years.
It is one of those "In the Event of a Spill" devices, an intervention that is supposed to protect our staff and our patients from trips and falls should liquid spills end up in the hallways of our practice.
Pull down and it pops open, a little hazard-yellow tripod, meant to stand guard and protect.
They're scattered at various points throughout the practice, tucked up in the corner on the walls, available should anyone notice anything spilled on the floor, be it water, coffee, urine, vomit, blood, or pretty much any other fluid one might encounter in a medical practice. It's meant to be a temporary thing, a warning, a "watch your step", something to tide us over until the appropriate cleanup can occur.
Now obviously, when I spill a cup of water, instead of putting a cone on it marking it as a potential hazard, I should probably just grab some paper towels and wipe it up.
But if a chemical hazard spill occurs, or a body fluid that needs safer and more effective cleanup, it makes sense that we warn patients and staff not to step in it, while we wait for appropriately armed personnel to arrive to safely eradicate the problem.
Unfortunately, this reminds me a little bit of institutional quality and patient safety efforts.
Across healthcare institutions, including our own, there are multiple committees and groups that get together to review quality improvement efforts and patient safety efforts, tracking errors in the practice, focusing on efforts to prevent, improve, and correct these by getting to the heart of the matter.
Every year, each practice is required to present, to each of these committees, a compilation of our quality improvement and patient safety efforts throughout the past year.
This includes a description of our practice and leadership structure (as if they do not already know who we are), and a compilation of the quality and patient safety team showing how reporting is done, essentially who does what, and then a long list of things that have been noted and responded to over the past year.
We have an electronic system in which safety issues can be reported, for errors and near-harm events, including such things as falls, mislabeled specimens, and other bad outcomes.
We have another system that collects patient complaints and grievances, which come to our practice from multiple sources, including individual providers, our administrators, and Patient Services.
And then we have a long list of projects we have done, things we have been working on over the past year meant to improve our performance on measures that we have either deemed important to our practice, areas where we have been found lacking, processes that have been analyzed and found to be fraught with errors or risk thereof, and regulatory requirements that necessitate the collection of data and the implementation of further practice improvement.
We also have extensive quality improvement education and curriculum within our practice, for the faculty and residents and medical students, which has in-itself led to quite a few successful projects that improve the way we take care of patients.
Those doing the work and seeing the errors are often best in a place to figure out a better way to do things. And sometimes you need a fresh pair of eyes to move us away from "we do it this way since this is how we have always done it".
But as our systems continue to evolve, I hope we move away from the collecting of data in all these small incremental steps aimed at improving quality and safety.
We're never going to be 100% error-free.
In a practice where we have many patients with many significant comorbidities, and gravity is in play, people are going to fall.
We have a water cooler in our waiting room, there will be spills.
Three to four hundred patients make their way through so many different interactions when they visit our practice, from registration to medical technician to provider to nurse to phlebotomist means nearly overwhelming opportunities to miss something or trip up on some minor detail.
But our staff has done an incredible job of identifying many of these problems, both environmental and structural, within our practice, as well as with the procedures we do and how we handle our patients, which have led to significant interventions to prevent slips, falls, and medical errors from happening.
One would think that in the 21st-century that it would be impossible to draw a patient's blood into a tube labeled with someone else's medical record number, but it happens.
Surgeons sign their sites, not because anyone thinks they are just operating willy-nilly, but because it is a chaotic storm of stuff we are working in, and we all need all the help we can get.
We can have endless meetings and endless discussions about what works in the airline industry or what worked for Toyota long ago, but as long as there are humans involved, there will always be errors.
I can only hope that as we continue to evolve and improve these processes, we're not just putting up a pop-up cone over a spill, and hoping no one slips and falls.
So we'll keep going to meetings, we'll keep reporting, we'll keep participating in all of these quality improvement and patient safety initiatives, but we need to make sure it's not just lip-service. Everyone needs to be fully engaged and the people in power need to make sure that we all have all the tools we need, that we're not rushed, that we're not burned-out, that we always treat each of our patients exactly as we would want one of our own family members to be treated.
When we do that, quality will improve, and patients will be safer, to the limits which we are able to get them to.

Doc: Empower patients in decision-making to reduce medical errors

Useless for stroke patients. There are no documented rehab stroke protocols with efficacy percentages so no real discussions are needed for stroke patients to choose the best recovery options. I don't see this happening for decades, if ever with the fucking failures of stroke associations we currently have.

 Doc: Empower patients in decision-making to reduce medical errors

When a baseball injury ended his surgical career, Lawrence Schlachter, M.D., decided he wanted to continue working for patients. So he went to law school and now represents patients as a medical malpractice attorney.
Over his years both in the operating room as a neurosurgeon and in the courtroom, Schlachter has seen trends emerge in the causes of malpractice and medical error and how they are handled by providers. He’s compiled his experiences both in the field of medicine and the field of law into a book titled Malpractice that’s due out early next year.
Schlachter said he was struck by recent study data from The BMJ that suggests medical errors may be the third leading cause of death in the U.S.—responsible for as many as 250,000 deaths per year—and said that those figures validate what he’s experienced in 15 years of law practice. And, he said, experts suggest that for every medical mistake that is litigated, at least 10 are brushed under the rug and patients never hear about the errors.
One of the key problems, Schlachter said, is poor communication, both between doctors and between doctors and patients. Physicians need to take accurate histories, he said, and ensure that they order correct tests. Patients, meanwhile, need to feel empowered to ask questions and be involved in decisions about their care.
Schlachter described one case in which a patient had a painful infected area on her back, but doctors were more concerned about her gastric symptoms and treated her for gastroenteritis despite her concerns. Within 24 hours, she went into septic shock and surgeons had to amputate all of her limbs, Schlachter said. A case like that, he said, is an example of a doctor failing to examine the patient correctly and failing to communicate effectively with her.
But patients also have to take some responsibility, Schlachter said. For instance, patients must be proactive when selecting doctors and should actively participate in decision-making. Because many patients may be nervous or reluctant to question medical professionals, he suggests providers accommodate them and encourage open discussion. Patients need to have strategies to protect themselves, too, he said.
“(Patients) don’t have to become annoying or inquisitory. All can be done in a normal fashion, and healthcare providers should answer the questions in a normal fashion,” Schlachter said. “I’m not trying to create a war zone between patients and doctors. … If I can start a conversation, if I can make people start questioning things more, I will be happy. I will have succeeded.”

Medical errors persist, despite increased scrutiny

These are just the explicit errors. They aren't even counting all the omission errors, like the 90% of stroke patients that don't get to full recovery or the 88% of the time tPA doesn't work to fully reverse the stroke. This amounts to completely fudging the numbers. By not reporting on those problems nobody will attempt to fix them. Stroke survivors once again getting screwed because of incompetence. And there are no consequences to the stroke department head for those failures.
http://www.bostonglobe.com/metro/2016/08/23/medical-errors-persist-despite-increase-scrutiny/VFguAOLAze61ZL6XduzSIO/story.html?
Preventable medical errors reported by full-service hospitals in Massachusetts grew 60 percent last year, a rise partly attributed to problems detected in a single hospital’s dialysis unit.
Hospitals disclosed 1,313 errors that harmed or threatened patients in 2015, including 26 cases when the wrong surgery or procedure was done on a patient; 51 instances when a medication error seriously injured or killed a patient; and 446 cases of contaminated drugs, devices, or biologics.
This last category, which accounted for only 37 reports in 2014, constituted most of the overall increase in reported errors.
Baystate Medical Center in Springfield notified 575 patients early this year that they were potentially exposed to infection after state inspectors, during a spot visit, found crowded and unsanitary conditions in the inpatient dialysis unit. Most of those patients received dialysis treatment in 2015 and the state Department of Public Health counted each one as a “serious reportable event.’’
Dr. Douglas Salvador, vice president of medical affairs at Baystate, said no patients are known to have contracted hepatitis B or hepatitis C, the primary concerns, as a result of the problems found in the unit.
During their January visit, health department inspectors found that the hospital did not follow proper infection control practices. Staff did not set aside dialysis machines for use only on patients with hepatitis B, and did not always thoroughly clean those machines before they were returned for use on other patients, investigators said. Dialysis is a treatment that uses a special machine to remove harmful wastes, salt, and excess fluid from the blood of patients with kidney failure.

Total number of serious preventable medical errors in acute care hospitals by year

2015 saw a large increase in the number of errors reported. Note: The significant increase in the number of errors reported from 2012 to 2013 can be attributed to the adoption of new definitions. The increase last year is largely due to problems at one hospital.

Baystate also exceeded its limit of eight dialysis patients per shift by crowding patients between stations and using portable machines, increasing the risk of contamination from blood splattering, inspectors found.
Salvador said the hospital is now isolating machines for use only on infected patients and no longer exceeds the limit on patients. He said the machines were being cleaned thoroughly, but that nurses were not always documenting their efforts.
“There are people who come in through the emergency department and need dialysis services, and the desire is to do one more and try to get them done,’’ he said. “There were a lot of good intentions.’’
A case of contamination of equipment at a second, unidentifed hospital also contributed to the overall increase.
The state Department of Public Health tracks preventable medical errors and releases the data annually to encourage hospitals and other providers to improve the quality of care. Research studies show that as many as one-third of patients nationally are harmed during their hospitalization, health officials said. Hospitals and outpatient surgery centers also are required to report these errors to patients who are impacted and their insurers.
Most categories of preventable errors fluctuate up and down from year to year. The data “reported in Massachusetts doesn’t tell us whether medical errors are increasing,’’ said Barbara Fain, executive director of the The Betsy Lehman Center, a state agency focused on improving patient safety.
Errors could be increasing because of pressure to serve sicker patients more quickly. But more reported errors could mean hospitals are getting better at detecting problems. And facilities that report more errors are not necessarily providing inferior care; they may do a better job of spotting harm and then correcting problems.
Fain also pointed out that the state data include only hospitals and surgery centers. “That leaves out many other settings where we know serious medical errors take place, like doctors’ offices and nursing homes,’’ she said. “Without more complete data it’s simply not possible to determine trends.’’
According to the health department report, surgical errors, such as leaving an instrument inside a patient, increasingly occur outside of operating rooms, in radiology, labor and delivery, and inpatient units. Falls and pressure ulcers are the two most common types of preventable incidents in most years.
Notably, 59 ambulatory surgery centers reported just four errors last year. They do not have as much experience as hospitals in developing systems to identify and track serious problems, underscoring the difficulty of drawing conclusions from the numbers.
“We’re concerned about the low level of reporting by (surgery centers) and that’s the reason for our initiatives,’’ said Fain, whose organization has developed an online tool to help providers identify and report errors.
Baystate Medical Center in Springfield notified 575 patients early this year that they were potentially exposed to infection after state inspectors, during a spot visit, found crowded and unsanitary conditions in the inpatient dialysis unit. Most of those patients received dialysis treatment in 2015 and the state Department of Public Health counted each one as a “serious reportable event.’’
Dr. Douglas Salvador, vice president of medical affairs at Baystate, said no patients are known to have contracted hepatitis B or hepatitis C, the primary concerns, as a result of the problems found in the unit.
During their January visit, health department inspectors found that the hospital did not follow proper infection control practices. Staff did not set aside dialysis machines for use only on patients with hepatitis B, and did not always thoroughly clean those machines before they were returned for use on other patients, investigators said. Dialysis is a treatment that uses a special machine to remove harmful wastes, salt, and excess fluid from the blood of patients with kidney failure.

Liz Kowalczyk can be reached at kowalczyk@globe.com. Follow her on Twitter @GlobeLizK.

Commentary: Evidence-based care best hope to eliminate medical errors

If you didn't get to 100% recovery that should be considered a medical error. What is your doctor and hospital doing to recognize all the points that need changing to get the next stroke survivor to 100% recovery? Any version of the statement 'All strokes are different, all stroke recoveries are different' is grounds for a screaming match against those people, because they know absolutely nothing about stroke recovery. The answers are out there but will take lots of research. YOU are going to have to get your stroke hospital to change for the better. Your hospital will not change otherwise. 

Commentary: Evidence-based care best hope to eliminate medical errors

By Bernadette Mazurek Melnyk  | June 11, 2016

For all of the discussions about cost, access and bureaucracy, it's becoming increasingly clear that one of the biggest problems we face in healthcare is inertia.

Ironically, in a field that is constantly evolving with new research and scientific knowledge, healthcare providers have a natural instinct to do things the same way they learned years ago and have always done them—and patients are paying the price.

A study by researchers at Johns Hopkins University, released in May, found that medical errors in hospitals and other healthcare facilities account for more than 250,000 deaths each year, a significant increase since an Institute of Medicine 1999 study, To Err Is Human, offered solutions for the healthcare system to achieve a better safety record. Suggestions included developing safety oversight programs, raising performance standards and instituting mandatory reporting for adverse medical events. Years later, though, it's clear that people are still dying more from their care than they are from diseases such as Alzheimer's or stroke.

This is unacceptable by any measure. But let's not jump to the conclusion that these dangerous errors are the result of carelessness or disregard for the patient's well-being. I can attest from years of teaching and working with nurses and other healthcare professionals that clinicians working in hospitals, clinics and primary-care offices are as dedicated as I have ever seen. The problem is that many have yet to develop the knowledge and skills to consistently deliver the best evidence-based care.

A follow-up IOM study in 2001, “Crossing the Quality Chasm,” offered six aims to improve the quality of care—among them, that effective care means “providing services based in scientific knowledge.” However, that gap in care between the growth of evidence-based practices and what is actually happening at the point of care still exists today. Evidence-based practice is an approach to healthcare that melds clinical expertise and patient preferences with data emanating from relevant, high-quality research. When we are able to support that a particular practice generates better health outcomes than traditional practice, clinicians should adapt and make that change. It's about prioritizing problem-solving and implementing best evidence over doing what's become comfortable.

I would guess that most patients already enter a hospital or healthcare system thinking they are going to be receiving evidence-based care. However, studies have shown that is not the standard of care in many facilities.

The implementation of best standards of patient care won't happen without a concerted, systemwide effort. We're trying to accelerate this movement by launching, in the fall of 2017, a national institute for evidence-based practice in nursing and healthcare that will be headquartered at Ohio State University. Our goal is to revolutionize the future of patient care by replacing practices that are steeped in tradition with the best evidence-based care. We're also going to be ramping up our advocacy for the kind of sensible steps that will integrate evidence-based practice into all care settings.

This begins with strengthening nursing curriculums at schools nationwide and educating nursing and other health sciences students on how to implement the steps of “EBP” and access the premier standards of care, so that they can implement them in their clinical practices. We need to create online hubs for healthcare providers to review best practices and have access to reliable resources. And, in the interest of dynamic learning, there must be a constant stream of webinars, conferences and summits to disseminate newly emerging research, evidence and knowledge.

The Johns Hopkins study only confirmed what we've known for years. Patients, regardless of where they are receiving care, deserve the benefits of breakthrough research and best practices. It may take many years to develop cures for cancer, heart disease and other life-threatening illnesses, but the quarter-million lives lost annually to medical errors is a problem we can begin fixing now.

About that Johns Hopkins study on medical errors (podcast)

Well excuses abound, complacency exists in massive amounts in stroke.
http://medcitynews.com/2016/05/hopkins-medical-errors-podcast/?utm_source=MedCity+News+Subscribers&utm_campaign=f55987a874-MCN+Daily+Email&utm_medium=email&utm_term=0_5092836c41-f55987a874-408818725
My reply to this, we'll see if it is published or replied to:

If the definition of medical error is broad, meaning systemic errors, then it could easily cover every single 30day stroke death. Mainly because the neuronal cascade of death has been known since the 2009 Rockefeller University Newswire report. The 5 known causes of that cascade are out there ready to be solved. Dr. Michael Tymianski of the Toronto Western Hospital Research Institute
in Canada talks about 1000+ failed neuroprotective research trials. Yes, that will be difficult to solve but leaders step up to such challenges and don't make excuses.

Medical Error Is Third Leading Cause of Death in US

I'm going to be outrageously provocative here and say that almost every single 30 day death from stroke is a medical error. This is because the stroke medical world has known about the neuronal cascade of death since at least 2009 and has not done enough to solve that problem and save hundreds of thousands of lives every year.  I don't give a shit about the feeble protestations of the stroke medical world.  They have had decades to get their shit in order and have completely failed causing massive amounts of death and disability. Tell me why I'm wrong.
http://www.medscape.com/viewarticle/862832?nlid=104512_3901&65&faf=1 
Marcia Frellick
Medical error is the third leading cause of death in the United States, after heart disease and cancer, according to findings published today in BMJ.
As such, medical errors should be a top priority for research and resources, say authors Martin Makary, MD, MPH, professor of surgery, and research fellow Michael Daniel, from Johns Hopkins University School of Medicine in Baltimore, Maryland.
But accurate, transparent information about errors is not captured on death certificates, which are the documents the Centers for Disease Control and Prevention (CDC) uses for ranking causes of death and setting health priorities. Death certificates depend on International Classification of Diseases (ICD) codes for cause of death, so causes such as human and system errors are not recorded on them.
And it's not just the US. According to the World Health Organization, 117 countries code their mortality statistics using the ICD system as the primary health status indicator.
The authors call for better reporting to help capture the scale of the problem and create strategies for reducing it.
Cancer and Heart Disease Get the Attention
"Top-ranked causes of death as reported by the CDC inform our country's research funding and public health priorities," Dr Makary said in an university press release. "Right now, cancer and heart disease get a ton of attention, but since medical errors don't appear on the list, the problem doesn't get the funding and attention it deserves."
He adds: "Incidence rates for deaths directly attributable to medical care gone awry haven't been recognized in any standardized method for collecting national statistics. The medical coding system was designed to maximize billing for physician services, not to collect national health statistics, as it is currently being used."
The researchers examined four studies that analyzed medical death rate data from 2000 to 2008. Then, using hospital admission rates from 2013, they extrapolated that, based on 35,416,020 hospitalizations, 251,454 deaths stemmed from a medical error.
That number of deaths translates to 9.5% of all deaths each year in the US — and puts medical error above the previous third-leading cause, respiratory disease.
In 2013, 611,105 people died of heart disease, 584,881 died of cancer, and 149,205 died of chronic respiratory disease, according to the CDC.
The new estimates are considerably higher than those in the 1999 Institute of Medicine report "To Err Is Human." However, the authors note that the data used for that report "is limited and outdated."
Strategies for Change
The authors suggest several changes, including making errors more visible so their effects can be understood. Often, discussions about prevention occur in limited and confidential forums, such as a department's morbidity and mortality conference.
Another is changing death certificates to include not just the cause of death, but an extra field asking whether a preventable complication stemming from the patient's care contributed to the death.
The authors also suggest that hospitals carry out a rapid and efficient independent investigation into deaths to determine whether error played a role. A root cause analysis approach would help while offering the protection of anonymity, they say.
Standardized data collection and reporting are also needed to build an accurate national picture of the problem.
Jim Rickert, MD, an orthopedist in Bedford, Indiana, and president of the Society for Patient Centered Orthopedics, told Medscape Medical News he was not surprised the errors came in at number 3 and that even those calculations don't tell the whole story.
"That doesn't even include doctors' offices and ambulatory care centers," he notes. "That's only inpatient hospitalization resulting in errors."
"I think most people underestimate the risk of error when they seek medical care," he said.
He agrees that adding a field to death certificates to indicate medical error is likely the way to get medical errors the attention they deserve.
"It's public pressure that brings about change. Hospitals have no incentive to publicize errors; neither do doctors or any other provider," he said.
However, such a major step as adding error information to death certificates is unlikely if not accompanied by tort reform, he said.
Still, this study helps emphasize the prevalence of errors, he said.
Human error is inevitable, the authors acknowledge, but "we can better measure the problem to design safer systems mitigating its frequency, visibility, and consequences."
They add that most errors aren't caused by bad doctors but by systemic failures and should 'not be addressed with punishment or legal action.