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These are the top 10 hospital mistakes that are never supposed to happen, but still do

Patient falls top the list

This afternoon, I spoke with a hospitalist expert about a medical malpractice case where an elderly patient broke her hip in a fall at a Houston area hospital. This happened despite a nursing fall risk assessment of her in the emergency room that tagged her as a high fall risk.

Hospital falls are considered sentinel or never event. This means that with proper nursing and medical care, falls in hospitals should be preventable. The standard of care requires a nursing fall risk assessment of every patient, and taking appropriate interventions to prevent falls.

Yet, despite this standard of care, hospital falls still happen with an increasing frequency. In 2021, healthcare accrediting agency, The Joint Commission, announced the highest number of sentinel event reports in its history. Do you care to guess what was number one on the list? Yes, it was patient falls.

Here is the 2021 Top 10 list of sentinel or never events most commonly reported to The Joint Commission by hospitals and other health care facilities:

#1:          Patient falls: 485 reports

We’ve handled numerous patient fall cases involving hospitals, nursing facilities, and rehabilitation facilities. Currently, we are working on cases where patients broke bones from falls in the emergency room and after being admitted to the hospital.

#2:          Delay in treatment: 97 reports

#3:          Unintended retention of a foreign object: 97 reports

These sentinel events involve surgical and operating room malpractice. We’ve handled cases where surgical gauze and even towels have been left inside patient abdomens by mistake. These items are magnets for infection and can cause serious injuries and additional surgeries and treatment.

#4:          Wrong surgical site: 85 reports

The standard of care requires surgical and anesthesia providers to participate in a surgical timeout. The idea is that the entire operating room team should pause before beginning of surgery to confirm the correct patient, correct surgery, and correct site. Sometimes, though, healthcare providers are too hurried and actually operate on the wrong patient or wrong surgical site. We’ve handled both types of claims.

#5           Patient suicide: 79 reports

#6:          Assault/rape/sexual assault of a patient: 55 reports

#7:          Patient self-harm: 45 reports    

#8:          Fire: 38 reports

#9:          Medication management: 35 reports

Medication errors can usually be avoided with vigilant medication reconciliation by the nursing staff, which must be carefully reviewed by a physician. This involves getting a list of all of the patient’s current and recent medications, so the doctor can have this important information when prescribing new medications. Hospital pharmacies also have a role in questioning or asking for clarification when they receive a prescription for an unusual dosage or for medication that may interact with something else that the patient is already taking.

#10:       Clinical alarm response: 22 reports

If you’ve been seriously injured because of one of these health care errors in Texas, then contact a top-rated experienced Texas medical malpractice lawyer for free consultation about your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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