Types and harms of medical errors in urology: results of reviews from 1999-2019

Background and objective Medical errors are comprised of various problems. Influencing factors include the diseases and procedures involved, the types of errors and the consequential harms of the respective treatment processes. Their contribution is determined for the first time in an extended systematic analysis of errors ascertained by a professional commission. Methods and results In all, 236 confirmed errors were analyzed based on 359 expert examinations by a professional commission from 1999 to 2019 regarding causes and consequences of errors. Errors occurring in a practice (103/43.6%) concerned diagnosis (69/29.3%) and therapy (34/14.4%). In contrast, errors occurring in a clinic (159/67.4%) concerned most often therapy (144/61.0%) and rarely diagnosis (15/6.4%). Some diseases and procedures were involved significantly more often than others, depending on their frequency and complexity or on the quality of treatment and the avoidance of errors. Types of errors were: diagnostics: inadequate examination (112/47.5%) or assessment (86/36.4%) of findings; indication: reason lacking (58/24.6%), disregarded or against (33/14.0%) intervention; information: inadequate explanation of risks (24/10.2%); therapy: inadequate performance of technique (59/25.0%), organization of treatment (16/6.8%), medication (6/5.5%); aftercare: inadequate follow-up (20/8.5%), information (15/6.3), management of complications (13/5.5%); documentation: inadequate (19/8.1%) and/or falsified (4/1.7%) records. Direct/primaryharms of errors were: complications (126/54.7%), Clavien 3/4 (120/50.8%), Clavien 5 (death; 16/6.8%), unnecessary surgery (39/16.5%) or medication (40/16.9); surgical revision (83/35.2%), revision with intensive care (55/14.9%), error correction for mistake made elsewhere in a clinic (131/55.1%) or practice (13/5.5%). Indirect/secondaryharms of errors were: delayed diagnosis/therapy (94/39.8%), functional or organic loss of kidney (6/2.5% or 7/3.0%), testis (2/0.8% or 22/9.3%), urinary sphincter (14/5.9%); extended/increased need of treatment (167/70.8%), prolonged suffering/diminished quality of life (173/73.3%), diminished chance of healing/prognosis (45/19.1%). Conclusion Based on a systematic analysis of medical reviews over two decades, a summary is provided regarding types of diseases and procedures that are particularly prone to error in urology, the types of errors in the treatment process that give rise to direct and indirect medical error, and the that consequences have to be drawn.