Hospital.Help

Berlin – Experts from the Medical Service identified 3,160 treatment errors by medical personnel last year that caused harm to patients. In total, the experts processed around four times as many suspected cases (12,438) in 2023, as the Federal Medical Service announced today in Berlin in its annual statistics. The previous year there were 13,059 allegations.

According to the reports, in one in five cases (2,679) the error was also the cause of the damage suffered – in which case those affected have a chance of receiving compensation. According to the evaluation, an error led to death in 75 cases (2022: 84).

Almost 30 percent of those affected suffered permanent damage. This includes mild, moderate and severe permanent damage, ranging from scars and chronic pain symptoms to the need for care, blindness or paralysis.

In three quarters of the suspected cases, it was found that there was no treatment error or error without damage, it said. The proportion of confirmed cases remains at an unchanged level, said the CEO of the Federal Medical Service, Stefan Gronemeyer.

The information relates to inpatient and outpatient cases in human and dental medicine as well as nursing.

They are not representative. Other allegations are processed by expert committees and arbitration boards of the medical associations, settled directly between patients and service providers or liability insurers, or negotiated in court, as the Medical Service explained.

In general, it is assumed that the number of unreported cases is higher. It is assumed that errors and avoidable damage occur in around one percent of inpatient treatments, according to the Medical Service.

Mandatory reporting for particularly serious cases required

In 151 cases, the experts saw 2023 so-called never events, i.e. events that should not have happened and that could certainly have been prevented with preventive steps. These included, for example, confusion of patients, sides or medications, as well as surgical material forgotten in the patient.

The deputy CEO and chief physician of the Bavarian Medical Service, Christine Adolph, cited as an example a 39-year-old patient who was scheduled to have a cyst removed but who was accidentally sterilized during the procedure.

Gronemeyer renewed his call for a nationwide reporting requirement for never events in order to better prevent such events. Identifying and analyzing the causes of errors is key to making progress in preventing them. Never events are rare, but they indicate inadequate security measures.

Such reporting systems are already being used successfully in many countries such as Great Britain, the USA, Australia and Switzerland, said Gronemeyer. The World Health Organization’s (WHO) global action plan also includes the goal that 90 percent of countries should introduce a reporting system for never events by 2023 at the latest.

“From a patient perspective, it is absolutely unacceptable that politicians are showing virtually no concrete efforts to implement this important goal in Germany,” said Gronemeyer. He stressed that it was not about assigning blame or sanctioning individuals, but about reviewing the processes for prevention purposes.

The proposal is therefore to record errors electronically, without any liability issues. A “trusted office” is needed, which must be provided with details and clarify the case, but which must not disclose any data on the patients and facilities affected.

Gronemeyer named the Robert Koch Institute (RKI) as a possible institution that could be considered for this task. When asked, no suggestion was made as to how such a position would be financed, but it is assumed that a lean structure could be possible.

Criticism of politics, with one exception

Gronemeyer criticized the lack of significant progress in improving the safety culture in medicine and nursing. There are some good initiatives in place, but there is a lack of a systematic strategy for better error prevention.

Unfortunately, politicians have so far remained largely inactive when it comes to the necessary legal framework for protecting patients. Gronemeyer expressly excluded the Federal Government’s Patient Commissioner, Stefan Schwartze (SPD), from his criticism.

With regard to hospital reform, it is to be welcomed that difficult operations and treatments will in future only be carried out in hospitals with proven competence and experience, said Gronemeyer.

However, with regard to factors such as the safety of the treatment process and the organization, the reform has not yet provided any clear impetus for greater patient safety. The reform lacks procedures for avoiding errors that have long been common practice abroad.

The German Foundation for Patient Protection also sharply criticized the way errors are handled in medicine. “Patients are being let down in this country. There is no culture of error in practices and nursing homes,” said board member Eugen Brysch.

The Federal Ministry of Health (BMG) announced that clinics and practices are already legally obliged to implement error reporting systems. “Evaluations in both the statutory health insurance sector and in hospitals show a high level of implementation of error management and error reporting systems,” the ministry said.

In order for those affected to be compensated, a hardship fund is needed, as promised in the coalition agreement. “It cannot be that the victims have to wait many years to get their rights,” criticized Brysch, and called on the Health Minister to draft a law. The BMG announced that it was examining whether a concept for the design of a hardship fund could be commissioned.

Most of the allegations recorded in the annual statistics relate to surgical interventions, so around two thirds of the suspected cases were inpatients. They are spread across various specialist areas, with orthopedics and trauma surgery showing the highest rates. In nursing, the problems are mostly problems such as pressure ulcers, which can arise due to incorrect positioning of patients.

However, the frequency of allegations depending on the field does not allow any conclusions to be drawn about the safety or error rate there, as Adolph stressed. “It simply shows that patients react to treatment results when these do not meet their expectations.” For example, it is easier for patients after hip surgery to compare their own condition and progress with other patients than after complex oncological treatments.

The Medical Service is a public corporation. Patients who suspect that they have been the victim of a medical error can go to their health insurance company, which can then commission the Medical Service to prepare a report. Proving that a medical error has occurred is difficult for patients. They are advised, for example, to make memoranda. © ggr/dpa/aerzteblatt.de