The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II
Lucian L. Leape,Troyen A. Brennan,Nan M. Laird,Ann G. Lawthers,A R Localio,B A Barnes,Liesi E. Hebert,Joseph P. Newhouse,Paul C. Weiler,Howard H. Hiatt +9 more
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The high proportion that are due to management errors suggests that many others are potentially preventable now, and reducing the incidence of these events will require identifying their causes and developing methods to prevent error or reduce its effects.Abstract:
Background In a sample of 30,195 randomly selected hospital records, we identified 1133 patients (3.7 percent) with disabling injuries caused by medical treatment. We report here an analysis of these adverse events and their relation to error, negligence, and disability. Methods Two physician-reviewers independently identified the adverse events and evaluated them with respect to negligence, errors in management, and extent of disability. One of the authors classified each event according to type of injury. We tested the significance of differences in rates of negligence and disability among categories with at least 30 adverse events. Results Drug complications were the most common type of adverse event (19 percent), followed by wound infections (14 percent) and technical complications (13 percent). Nearly half the adverse events (48 percent) were associated with an operation. Adverse events during surgery were less likely to be caused by negligence (17 percent) than nonsurgical ones (37 percent). The proportion of adverse events due to negligence was highest for diagnostic mishaps (75 percent), noninvasive therapeutic mishaps ("errors of omission") (77 percent), and events occurring in the emergency room (70 percent). Errors in management were identified for 58 percent of the adverse events, among which nearly half were attributed to negligence. Conclusions Although the prevention of many adverse events must await improvements in medical knowledge, the high proportion that are due to management errors suggests that many others are potentially preventable now. Reducing the incidence of these events will require identifying their causes and developing methods to prevent error or reduce its effects.read more
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BookDOI
To Err Is Human Building a Safer Health System
TL;DR: Boken presenterer en helhetlig strategi for hvordan myndigheter, helsepersonell, industri og forbrukere kan redusere medisinske feil.
Journal ArticleDOI
Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I.
Troyen A. Brennan,Lucian L. Leape,Nan M. Laird,Liesi E. Hebert,A R Localio,Ann G. Lawthers,Joseph P. Newhouse,Paul C. Weiler,Howard H. Hiatt +8 more
TL;DR: There is a substantial amount of injury to patients from medical management, and many injuries are the result of substandard care.
Journal ArticleDOI
Incidence of Adverse Drug Events and Potential Adverse Drug Events: Implications for Prevention
David W. Bates,D J Cullen,Nan M. Laird,Laura A. Petersen,Small Sd,Servi D,G Laffel,Bobbie Jean Sweitzer,Shea Bf,Hallisey R +9 more
TL;DR: Adverse drug events were common and often preventable; serious ADEs were more likely to be preventable and prevention strategies should target both stages of the drug delivery process.
Journal ArticleDOI
Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002:
R. Monina Klevens,Jonathan R. Edwards,Chesley L. Richards,Teresa C. Horan,Robert P. Gaynes,Robert P. Gaynes,Daniel A. Pollock,Denise M. Cardo +7 more
TL;DR: HAIs in hospitals are a significant cause of morbidity and mortality in the United States and the method described for estimating the number of HAIs makes the best use of existing data at the national level.
Journal ArticleDOI
The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada
G. Ross Baker,Peter G. Norton,Virginia Flintoft,Régis Blais,Adalsteinn D. Brown,Jafna L. Cox,Edward Etchells,William A. Ghali,Philip C. Hébert,Sumit R. Majumdar,Maeve O'Beirne,Luz Palacios-Derflingher,Robert J. Reid,Sam Sheps,Robyn Tamblyn +14 more
TL;DR: The overall incidence rate of AEs of 7.5% in this study suggests that, of the almost 2.5 million annual hospital admissions in Canada similar to the type studied, about 185 000 are associated with an AE and close to 70 000 of these are potentially preventable.
References
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Book
Simultaneous Statistical Inference
TL;DR: In this article, the authors presented a case of two means regression method for the family error rate, which was used to estimate the probability of a family having a nonzero family error.
Journal ArticleDOI
Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I.
Troyen A. Brennan,Lucian L. Leape,Nan M. Laird,Liesi E. Hebert,A R Localio,Ann G. Lawthers,Joseph P. Newhouse,Paul C. Weiler,Howard H. Hiatt +8 more
TL;DR: There is a substantial amount of injury to patients from medical management, and many injuries are the result of substandard care.
Journal ArticleDOI
Normal Accidents: Living with High-Risk Technologies
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Journal ArticleDOI
Continuous improvement as an ideal in health care.
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