2023-08-17 17:06:00
View of an operating room during an intervention in the Asklepios Klinikum Harburg. There are many treatment errors, especially in operations.
Photo: dpa/Marcus Brandt
At 13,059 cases in 2022, the number of expert opinions prepared by the Medical Service (MD) on suspected treatment errors remained roughly the same as in the previous year. In every fourth case examined, a defect and damage were found, and in every fifth case the defect was the cause of the health impairment suffered. In 84 cases, the experts came to the conclusion that treatment errors were the cause of the death of a patient or contributed significantly to it.
This emerges from the current annual statistics of the MD, which were presented on Thursday in Berlin. However, according to the MD, a very high number of unreported cases can be assumed, because according to surveys, only three percent of all possible treatment errors are reported to the health insurance companies and then examined.
The current statistics show that there are still significant deficits in the quality of care and patient safety in Germany’s clinics and outpatient care facilities, said Stefan Gronemeyer, Chairman of the MD at the presentation. Especially since the frequency of certain damaging events has hardly changed in recent years. This applies, among other things, to medication errors and patient mix-ups, for example due to incorrectly assigned X-ray images.
Although these so-called “never events” are comparatively rare, they indicate systemic deficiencies in the supply process and in the safety precautions, according to Gronemeyer. The term, borrowed from aviation, describes errors that would not occur if all safety rules were observed. Common loss events of this type include bedsores (bed sores) during an in-patient stay, foreign objects left behind during surgery, and surgery on the wrong part of the body.
Unlike in many other countries, Germany has not yet had a binding reporting system for these “never events”. However, the MD board warns that a viable prevention system for these sources of error can only be developed with a comprehensive, pseudonymised and sanction-free reporting system.
Most treatment errors – about two thirds – are reported from inpatient treatment and confirmed by experts. 32 percent relate to surgical therapies, 23 percent to the diagnosis, followed by errors in care at 14.1 percent. Complaints about hip and knee joint operations as well as incorrect therapy for arm, leg and shoulder fractures and disc damage are among the front runners.
Gronemeyer is hoping for positive effects on the “safety culture” from the forthcoming hospital reform and the desired professional specialization of many hospitals. When asked whether the lack of skilled workers and the sometimes extreme overwork of the staff was not also a major breeding ground for treatment errors, the MD chairman reacted rather cautiously. Of course, sufficient staffing and good working conditions are important prerequisites for high-quality and, above all, safe patient care. But many of the common mistakes could be avoided, above all, through better documentation of the course of treatment, diagnoses and “process optimization”.
For Gronemeyer, an appropriate error culture also includes dealing with damage events within the clinics without taboos. A “pronounced hierarchical thinking” often prevents errors from being discussed. However, it must become a matter of course that even a young resident doctor should be able to ask critical questions of an experienced senior doctor in relation to certain courses of therapy without fear.
The German Foundation for Patient Protection also spoke up on Thursday. She accuses the federal government of abandoning victims of treatment errors and calls for a hardship fund. “The federal government is far from strengthening the position of patients in the health system,” said foundation board member Eugen Brysch of the “Neue Osnabrücker Zeitung” on Thursday. So far, the medical service, courts and medical association have each kept their own statistics on treatment errors, but “grievances can only be recognized if there is complete documentation,” said the patient advocate. Brysch called on Federal Health Minister Karl Lauterbach (SPD) to strengthen patient rights by law. This includes “in any case also a reversal of the burden of proof in favor of the injured party”. A requirement for which Gronemeyer also has “full understanding”. But that will be difficult to enforce, so now is the time to focus on what is immediately feasible in protecting patients from avoidable errors.
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