The Risk of veterinary medical errors
I started this blog to discuss how to improve veterinary medicine. My overall goal to encourage continuous improvement in quality. As written previously, I believe quality veterinary medicine is: safe, reliable, and effective healthcare that puts pets and their families first. I list safety first because I agree with the Mayo Clinic, “In order to be trusted, we must be safe.” Even our best veterinary institutions struggle on how to provide safe care. An interesting new journal publication demonstrates that veterinary medical errors are an important issue for us to understand and address.
We know that medical errors and other adverse events in hospitals are a major risk to people. A 2016 study in the British Medical Journal estimated that medical errors cause 250,000 deaths a year, putting it as the 3rd leading cause of death in the United States.
There have been limited publications in veterinary medicine about the incidence of errors and other adverse events. A survey study published in JAVMA in 2018 reported that of 606 responding veterinarians, 73% had been involved in at least one near miss or adverse event. However, because there is no requirement for reporting of medical errors or adverse event in veterinary medicine, no one knows the true incidence.
A New Study on Veterinary Medical Errors
The new study, published this year in Frontiers of Veterinary Science, presents one academic veterinary teaching institution’s experience with adverse event reporting. The college started a voluntary reporting system several years ago in its small animal, large animal and associated specialty practice hospital. The goal was to encourage discussion of errors in an atmosphere emphasizing learning and improvement. The reports were kept in a database so that they could be studied individually in the moment but also in the aggregate. The system allows for categorization of different types of errors and categorization by severity.
Errors reported into the system over a 3-year period from all three hospital locations were examined for the study. A total of 560 incidents were reported. While many errors had no harm, 8% led to either permanent harm or death of the pet.
Incidents were categorized as medication, iatrogenic, system, communication, lab, oversight, staff or equipment. Medication errors were the most common with dosing errors being the most common subcategory.
The incidence of errors in the hospital was calculated as 5 per 1000 patient visits. This incidence is very likely an under-representation of the true error rate. Most studies in human medicine have shown that voluntary systems do not catch all errors that occur. Many people, even in cultures where people are thanked for reporting, are scared to discuss errors. In addition, reporting can be missed due to time constraints or forgetting on a busy day. Despite these caveats, the number of reported errors means that this hospital group was dealing with an average of 3-4 errors every week.
Medical errors are a demonstrated contributor to emotional burnout in healthcare.
Two studies in veterinary medicine have confirmed the adverse impact of serious errors on confidence and mental health. It is crucial to understand that errors occur in our veterinary hospitals on a frequent basis. Our profession can not address the important issues of burnout and wellbeing unless we talk openly about the incidence of medical errors and work to fix the SYSTEMS that can be a root cause.
Studies have also shown that the way in which we respond to medical errors can impact the resilience of the professional. A study of spay neuter veterinarians demonstrated that those veterinarians that received technical learning, perspective and appraisal, support and collegiality, and emotional learning were more likely to recover from the event.
More Research is Needed
This study is an important contribution to the veterinary literature and demonstrates how adverse event reporting can be used for learning and appraisal. It shows that errors occur in veterinary healthcare, even in our best hospitals, and are a contributor to harm to our patients.
I hope that studies like this will encourage a larger discussion of medical errors in veterinary medicine. I believe that increased training on building cultures of safety, system quality improvement, and how to respond to medical errors will help us build true quality care that supports veterinarians and the pet families they serve.
