There is a grim joke that circulates among medical residents: Hospitals are terrible places for sick people.
Truth is, for all the life-saving miracles unfolding each day at modern hospitals — from cancer chemotherapy to heart bypass surgery — they are also filled with danger.
"It's human frailty," says Carol Haraden, a vice president at the Institute for Healthcare Improvement, which several years ago started an effort to reduce the toll from medical mistakes. "If you've got humans involved you're going to have errors. You just have to build a system that is going to prevent as many as possible."
Plenty get through. There are some 100,000 people who get potentially deadly infections during hospital treatment, according to the Centers for Disease Control. Infected incisions are particularly dangerous as hospital germs are more likely to be resistant to antibiotics that doctors use to kill them off.
Worse, between 40,000 and 100,000 people die every year because of doctors' mistakes, 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.
In one 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.) The wife of a patient whose brain was damaged in a car accident wrote in the journal Health Affairs about how a misplaced catheter and a blood clot led to the amputation of her husband's hand. Haraden herself, the medical-error expert, says that when she went to the hospital for breast cancer surgery, doctors almost operated on the wrong breast. (The mistake was caught before any operating was done.)
Managing these risks often comes down to persistent attention to detail — by caregivers, patients and their advocates. One study showed doctors only washed their hands 44 percent of the time, if nobody was looking. If they knew they were being watched, 61 percent washed up — still way too low.
At least we're 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. Today hyper-vigilant hospitals have managed to go months or years without a case of ventilator pneumonia. 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. At Cincinnati Children's Hospital Medical Center in Ohio, such steps resulted in a 90 percent reduction in ventilator pneumonia.
Another fix is to smooth out the massive volatility in patient traffic. A sudden flood of patients leads to all sorts of complications — from careless mistakes brought on by sleep deprivation, to patients getting treated for one condition by nurses who specialize in another.
Oddly — or sadly — enough, overcrowding in hospitals is actually the result not of sudden infectious outbreaks, but of the inefficient way surgeons book their operating rooms, says Eugene Litvak, a Boston University operations management expert. Urgent cases, like broken limbs, come in a steady stream. It's actually operations scheduled months ahead of time that cause overcrowding.
"It is easier for practically every hospital to predict when somebody will break their leg than when someone will schedule surgery," Litvak lamented to Forbes in April. "God doesn't make people sicker on Tuesday than Wednesday. We do."