Never mind the superbugs

Tony Blair was given a rough ride last week for daring to suggest that the latest MRSA mortality rates were not unduly worrying. Though the truth hurts, he was right. Compared to all the other things you can die from in hospital, perishing at the hands of a hospital acquired infection is relatively unlikely. For, of the 11 million people admitted to hospital each year, around 240,000 don't make it out alive. Of these deaths, it is estimated that 12% - more than 28,000 - are thought to be avoidable. Of these, just 955, according to latest Office of National Statistics figures for 2003, were caused by MRSA. Here, then, bearing in mind that clinicians do not intend to make errors, are the things you should really be worried about.

Error or delay in diagnosis

Failure to distinguish a potentially life-threatening condition from a harmless ailment costs lives. Charles Vincent, Professor of Clinical Safety Research at Imperial College, estimates that one-third of all avoidable and preventable accidents in hospitals are caused by diagnostic blunders. From missed malignancies and undiagnosed heart attacks to meningitis cases masquerading as common colds, thousands of patients die needlessly each year because their physicians fail to diagnose swiftly and correctly.

Drug problems

Over-stretched clinicians getting dosages and drugs mixed up is another common cause of preventable death in hospitals. One well publicised case of mistaken identity in recent years occurred in the treatment of children with acute lymphatic leukaemia. Patients were supposed to be given two different drugs. One, vincristine, was to be injected into the blood. The other, methotrexate, was to be injected into the spine. Confusing the two, as some young patients tragically discovered, can be fatal.

Failure to employ indicated tests

For a good number of dangerous maladies, there is a tried and tested method of working out whether a person has developed the condition. Say a patient goes to see her GP with a nasty cough which, unbeknown to both parties, is actually pulmonary tuberculosis. The patient might be sent home and told to rest when a simple x-ray would immediately reveal the severity of her complaint. More common in primary care - though less life-threatening - is a failure to employ urine or blood tests when dealing with patients who may have diabetes.

Slip-ups in the operating theatre

According to the Department of Health paper, An Organisation with a Memory, 400 people die or are seriously injured in procedures involving medical devices each year. Even more suffer as a result of surgical cock-ups. Take the 11 patients who died over two years in hospitals in England and Wales because feeding tubes were accidentally fed into their lungs rather than their stomachs, or the Cardiff man who had the wrong kidney removed. Less sensational but more common are mishaps with relatively common procedures, such as putting in a cardiac valve or fitting a pacemaker.

Failure to act on test results

According to Sir Brian Jarman, chair of the Bristol Inquiry which investigated unnecessary deaths of infants undergoing cardiac surgery, this is one of the most common causes of avoidable deaths. All too often, abnormal results get lost in transit - perhaps between the ward doctor and a specialist - and the delay can be perilous.

Avoidable delay in treatment

Waiting lists might be shorter than they have been in years, but thousands die each year while waiting for treatment for life-threatening conditions.

Poor follow-up of treatment

Care doesn't stop at the out-patients' door, and a good number of unlucky folk meet their end because no one keeps tabs on them after they are discharged. This might be someone taking treatment for hypertension, whose blood pressure sky rockets unchecked, or a diabetic accidentally overdosing on insulin.

Lack of preventative treatment

Sometimes lives are lost because of a failure to predict and forewarn of oncoming problems. This might be as simple as failing to make sure that people don't smoke or drink to excess, or ensuring that a child with rickets gets sufficient Vitamin D.

Use of outmoded tests or therapy

Doctors don't always keep up with medical developments and carry on using methods long since discredited. Failing to move with the times can cost lives.

Hospital acquired infections

While MRSA is not likely to destroy human life as we know it, there are strong indicators that the Office of National Statistics' projection of 955 deaths may conceal a deeper problem: the National Audit Office, the government's spending watchdog, estimates the MRSA figure to be nearer 5000.