Medical errors claim the lives of roughly 685 Americans per day─ more people than die of respiratory disease, accidents, stroke and Alzheimer’s. That estimate comes from a team of researchers led by a professor of surgery at Johns Hopkins. It means  medical errors rank as the third leading cause of death in the U.S., behind only heart disease and cancer.

In a new study published in the British Medical Journal, they define medical error broadly as:

An unintended act (either of omission or commission) or one that does not achieve its intended outcome, the failure of a planned action to be completed as intended (an error of execution), the use of a wrong plan to achieve an aim (an error of planning), or a deviation from the process of care that may or may not cause harm to the patient.  Patient harm from medical error can occur at the individual or system level. …We focus on preventable lethal events to highlight the scale of potential for improvement. The role of error can be complex. While many errors are non-consequential, an error can end the life of someone with a long life expectancy or accelerate an imminent death.

Because federal officials at the Centers for Disease Control and Prevention do not  record medical error as a cause of death, and it typically is not listed as a cause on death certificates, the researchers said, this lethal and likely preventable harm goes undetected and uncorrected. They said this lack of information should change, and their estimate of 250,000 deaths annually of Americans due to medical error also may be low.

Only a fraction of the victims of these medical errors bring medical malpractice lawsuits, in part because of the failure of providers to acknowledge candidly to patients and families that errors caused the harm.

Federal officials report that some of Americans’ top killers─besides the 250,000 whose deaths each year are attributed by experts to medical error ─include, in order, by annual deaths: heart disease (614,348), cancer (591,699), respiratory disease (147,101), accidents (136,053), stroke (133,103), Alzheimer’s (93,541), and diabetes (76,488).

The researchers looked at several studies of fatal medical errors since the Institute of Medicine (IOM) issued its landmark 1999 study that found, based on even older works, an incidence of as many as 98,000 deaths annually. Experts have agreed the IOM figure was too low. The latest estimates were reached by “comprehensive analysis of four large studies, including ones by the Health and Human Services Department’s Office of the Inspector General and the Agency for Healthcare Research and Quality that took place between 2000 to 2008,” the Washington Post says. The researchers say in their study:

“We calculated a mean rate of death from medical error of 251,454 a year using the studies reported since the 1999 IOM report and extrapolating to the total number of U.S. hospital admissions in 2013. We believe this understates the true incidence of death due to medical error because the studies cited rely on errors extractable in documented health records and include only inpatient deaths.”

Experts said the estimates were surprising, mostly because they showed how little progress physicians and hospitals had made since the 1999 IOM study. If the numbers proved jarring, especially to the public, this would be a good way to force caregivers to improve individual and systemic issues that result in medical errors, including misdiagnoses, surgical complications that go unrecognized, and mix-ups with the doses or types of medications patients receive. Doctors, nurses, and hospitals can’t better care for patients if they can’t even talk about incidents of bad care.

For the medical profession, errors, including in misdiagnosis, have become a hot topic. The esteemed New England Journal of Medicine in December published a major study and accompanying editorial that argued that, “Diagnostic errors are clinically and financially more costly today than ever before. Efforts to identify, monitor, and reduce the rates of such errors therefore require greater attention and more dedicated resources than they’ve received in the past.”

As Dr. Martin Makary, a surgeon at Johns Hopkins and the lead author of the medical error study, told the New York Times: “Humans will always make mistakes, and we shouldn’t expect them not to. But we can engineer safe medical care to create the safety nets and protocols to address the human factor. Measuring the magnitude of the problem is the first step.”