The economic burden of medical errors and policy solutions for patient safety: evidence from a mixed-methods study in...

This study aims to estimate the direct economic burden of major medical errors and identify feasible policy Solutions for improving patient safety in an Iranian tertiary hospital context.

A sequential explanatory mixed-methods design was adopted. In the quantitative phase, all medical errors reported between 2019 and 2023 were analyzed using the Ministry of Health's 29-item taxonomy. The three most frequent and cost-measurable categories - patient falls with severe injury, retained surgical items, and wrong-site surgery -were selected for micro-costing analysis. In the qualitative phase, two focus group discussions with eight safety experts were conducted, guided by the WHO Patient Safety Cost Framework. Data were analyzed using descriptive statistics and directed content analysis.

Patient falls generated the highest direct cost (USD 526 per case), followed by retained surgical items (USD 412) and wrong-site surgery (USD 71). The largest cost components were hospital stay, consumables, and therapeutic procedures. Qualitative findings highlighted systemic issues such as staff shortages, weak safety culture, poor checklist compliance, and a lack of digital monitoring technologies.

The study recommends strengthening human resource management, fostering a non-punitive safety culture, adopting RFID/barcode technologies for surgical tracking, implementing digital Time-Out monitoring, and investing in smart hospital infrastructure to prevent costly medical errors.

This research provides the first comprehensive mixed-methods economic evaluation of medical errors in Iran, integrating financial data with policy-level analysis. The results offer evidence-based insights for healthcare administrators and policymakers seeking cost-effective Solutions to enhance patient safety and hospital efficiency.