Medical errors are the third leading cause of death for Americans, claiming a quarter of a million lives a year, according to study results released by researchers at Johns Hopkins University.

If fatalities resulting from mistakes and safety lapses in medical care were counted as deaths, as are deaths from disease and injury, they would account for more fatalities than respiratory disease, and trail only heart disease and cancer as a cause of death, argues researchers in the report, published in the British Medical Journal.

To better track, research and avoid medical errors in the future, the authors of the BMJ study call for a space on death certificates where doctors can indicate that a medical error contributed to the death. 

Perhaps because doctors and hospitals would worry that admitting errors might invite lawsuits, the Johns Hopkins authors alternatively suggest a system in which hospitals can investigate whether errors contributed to a death, assured that "data acquired for quality improvement is not discoverable" in a court of law. 

The need for better data is clear, the authors note. "Measuring the consequences of medical care on patient outcomes is an important prerequisite to creating a culture of learning from our mistakes.”

Quality initiatives at healthcare organizations suggest that providers are interested in using process improvement to avoid future errors. At least one attempt to collect that information had high response rates and found that 5 percent of deaths may have been preventable. At Brigham and Women's Hospital in Boston, staff are even blogging about case studies of medical mistakes and the hospital's attempts to prevent them from happening again.

Medical errors can include delivering the wrong drug, misreading a patient's chart, or operating on the wrong organ. A report by the Institute of Medicine in 1999 alerted America to the toll, estimating that medical errors killed from 44,000 to 98,000 people a year.

The estimate draws on four studies of deaths due to errors that have come out since the 1999 report. The authors extrapolate from those findings to reach their estimate of 251,000 annual deaths. Even that figure, they say, probably underestimates the actual toll, because it includes only deaths in hospitals, not in outpatient surgery centers, nursing homes or other healthcare settings. 

That doesn't mean deaths from medical errors have increased since the 1990s. Because different methodologies were used to calculate the numbers, it's hard to say what the trend looks like.

The American Hospital Association said in an emailed statement that while "one incident is too many," the industry has made progress. The group cited federal data indicating that one type of patient harm, hospital-acquired infections, dropped by 17 percent between 2010 and 2014.

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