More made-up news about patient harms.

Following up on last month’s post on the fallacy of medical error as the third leading cause of death in the US, here is another wrinkle on the topic. A website called “Health Exec: For Leaders of Provider Institutions” published a brief article entitled “Top 10 Harms Patient’s Experience in Hospitals.” It begins with this: “Medical mistakes are one of the leading causes of death in the US.”

The Health Exec story is based on a white paper, “Top 10 Patient Harms in US Hospitals Based on EHR Data-2019,” from Pascal Metrics, an organization that uses the Global Trigger Tool to analyze data from electronic health records [EHR] in real time. If the Pascal Metrics list was generated from EHR data, its validity should already be suspect. But as you will see, no such data was used to create the 10 Harms list.

Because of space considerations, I will not critique all 10 items on the list but will focus on the most egregious falsehoods.

Number 4 on the list is Abnormal Surgical Bleeding:

From the article: “Abnormal surgical bleeding is unexpected blood loss that occurs following an invasive procedure. In a study that looked at patients who received a wide variety of specialty surgeries, 29.9% experienced bleeding complications, with associated costs ranging from $2,805 for patients who experienced said complications from reproductive organ surgeries to $17,279 for spinal surgeries.”

Let’s start with the fact that this study was published in 2011 and was based on administrative data for the years 2006 and 2007. It could hardly be relevant to 2019.

The paper involved several hundred thousand inpatients undergoing various types of major surgery. The incidence of bleeding complications was exaggerated in a clever way. Here’s how. For almost 104,000 cardiac operations, 47.4% of patients had some sort of “bleeding-related consequence,” which included blood transfusion. However, only 3.1% patients required reoperation. In other words, the authors considered a blood transfusion alone a significant event. The authors must have assumed that cardiac surgery patients are not supposed to bleed at all.

A 2018 paper in Annals of Thoracic Surgery measured pre-and postoperative blood volumes in 54 patients who underwent cardiac surgery and found that the average red blood cells loss was 38%. Therefore, that 40% of cardiac surgery patients might need a blood transfusion is not unexpected.

Number 6 is Organ Injury/Repair/Removal and mentions a Florida surgeon who, during a spine operation, removed a healthy kidney thinking it was a tumor. Last year, I blogged about this case, which occurred in 2016. So this is a series of one patient.

Number 9, Falls with Injury, gives no data about the incidence of falls with injury but rather says “in 2008, one health system had to pay $2.5 million to a patient who fell in their ER.” How this series of one patient in 2008 relates to the top 10 harms in 2019 is a mystery.

The methodology said to have been used to formulate Pascal Metrics’ top 10 list of patient harms was “adverse event outcomes data generated from its cloud-based multitenant automated patient safety and quality improvement system between June 1, 2018 and May 30, 2019.” Yet every one of the top 10 patient harms was actually derived from published research papers, records of a lawsuit, or the television program Inside Edition.

Health Exec for Leaders reported this garbage without questions. We can only assume that some hospital leaders read and believed it, which is shameful.


Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times.For the last 9 years, he has been blogging at and tweeting as @SkepticScalpel. His blog has had more than 3,700,000 page views, and he has over 21,000 followers on Twitter.