More than 250,000 deaths per year are due to medical error in the U.S, according to an eight-year analysis by doctors at Johns Hopkins University School of Medicine. Their data, published May 3 in The BMJ, surpasses the U.S. Centers for Disease Control and Prevention’s (CDC’s) third leading cause of death — respiratory disease, which kills close to 150,000 people per year.

“Top-ranked causes of death as reported by the CDC inform our country’s research funding and public health priorities,” said Martin Makary, M.D., M.P.H., professor of surgery at the Johns Hopkins University School of Medicine. “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.”

Currently, death certification in the U.S. relies on assigning an International Classification of Disease (ICD) code to the cause of death, and causes of death not associated with an ICD code, such as human and system factors, are not captured. As a result, accurate data on deaths associated with medical error is lacking, but recent estimates suggest a range of 210,000 to 400,000 deaths a year among hospital patients in the U.S, according to background information in the study.

“Incidence rates for deaths directly attributable to medical care gone awry haven’t been recognized in any standardized method for collecting national statistics,” said  Makary. “The medical coding system was designed to maximize billing for physician services, not to collect national health statistics, as it is currently being used.”

Using studies from 1999 onwards – and extrapolating to the total number of U.S. hospital admissions in 2013 – Makary and co-author Michael Daniel of Johns Hopkins calculated a mean rate of death from medical error of 251,454 a year.

The authors acknowledged that human error is inevitable, but say “although we cannot eliminate human error, we can better measure the problem to design safer systems mitigating its frequency, visibility, and consequences.”

They believe strategies to reduce death from medical care should include three steps:

  1. Making errors more visible when they occur so their effects can be intercepted.
  2. Having remedies at hand to rescue patients.
  3. Making errors less frequent by following principles that take human limitations into account.

For instance, instead of simply requiring cause of death, they suggest that death certificates could contain an extra field asking whether a preventable complication stemming from the patient’s medical care contributed to the death. Another strategy would be for hospitals to carry out a rapid and efficient independent investigation into deaths to determine the potential contribution of error.

Measuring the consequences of medical care on patient outcomes “is an important prerequisite to creating a culture of learning from our mistakes, thereby advancing the science of safety and moving us closer towards creating learning health systems,” they wrote.”Sound scientific methods, beginning with an assessment of the problem, are critical to approaching any health threat to patients,” they write. “The problem of medical error should not be exempt from this scientific approach.”