Incidence and types of adverse events and negligent care in Utah and Colorado.

BACKGROUND The ongoing debate on the incidence and types of iatrogenic injuries in American hospitals has been informed primarily by the Harvard Medical Practice Study, which analyzed hospitalizations in New York in 1984. The generalizability of these findings is unknown and has been questioned by other studies. OBJECTIVE We used methods similar to the Harvard Medical Practice Study to estimate the incidence and types of adverse events and negligent adverse events in Utah and Colorado in 1992. DESIGN AND SUBJECTS We selected a representative sample of hospitals from Utah and Colorado and then randomly sampled 15,000 nonpsychiatric 1992 discharges. Each record was screened by a trained nurse-reviewer for 1 of 18 criteria associated with adverse events. If > or =1 criteria were present, the record was reviewed by a trained physician to determine whether an adverse event or negligent adverse event occurred and to classify the type of adverse event. MEASURES The measures were adverse events and negligent adverse events. RESULTS Adverse events occurred in 2.9+/-0.2% (mean+/-SD) of hospitalizations in each state. In Utah, 32.6+/-4% of adverse events were due to negligence; in Colorado, 27.4+/-2.4%. Death occurred in 6.6+/-1.2% of adverse events and 8.8+/-2.5% of negligent adverse events. Operative adverse events comprised 44.9% of all adverse events; 16.9% were negligent, and 16.6% resulted in permanent disability. Adverse drug events were the leading cause of nonoperative adverse events (19.3% of all adverse events; 35.1% were negligent, and 9.7% caused permanent disability). Most adverse events were attributed to surgeons (46.1%, 22.3% negligent) and internists (23.2%, 44.9% negligent). CONCLUSIONS The incidence and types of adverse events in Utah and Colorado in 1992 were similar to those in New York State in 1984. Iatrogenic injury continues to be a significant public health problem. Improving systems of surgical care and drug delivery could substantially reduce the burden of iatrogenic injury.

[1]  L L Leape,et al.  Preventing medical injury. , 1993, QRB. Quality review bulletin.

[2]  L. Andrews,et al.  An alternative strategy for studying adverse events in medical care , 1997, The Lancet.

[3]  T. Brennan,et al.  The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. , 1991, The New England journal of medicine.

[4]  N. Laird,et al.  Incidence of Adverse Drug Events and Potential Adverse Drug Events: Implications for Prevention , 1995 .

[5]  D. Bates,et al.  Systems analysis of adverse drug events. ADE Prevention Study Group. , 1995, JAMA.

[6]  Timothy M. Franz,et al.  Enhancement of clinicians' diagnostic reasoning by computer-based consultation: a multisite study of 2 systems. , 1999, JAMA.

[7]  D. L. Simms,et al.  Normal Accidents: Living with High-Risk Technologies , 1986 .

[8]  D S Stein,et al.  Factors related to errors in medication prescribing. , 1997, JAMA.

[9]  T A Brennan,et al.  Reliability and Validity of Judgments Concerning Adverse Events Suffered by Hospitalized Patients , 1989, Medical care.

[10]  Robert L. Helmreich,et al.  3 Human factors in the operating room: interpersonal determinants of safety, efficiency and morale , 1996 .

[11]  J. Elmore,et al.  Variability in radiologists' interpretations of mammograms. , 1994, The New England journal of medicine.

[12]  T. Brennan,et al.  Using a computerized sign-out program to improve continuity of inpatient care and prevent adverse events. , 1998, The Joint Commission journal on quality improvement.

[13]  T. Clemmer,et al.  A computer-assisted management program for antibiotics and other antiinfective agents. , 1998, The New England journal of medicine.

[14]  L. Leape.  Error in Medicine , 1994 .

[15]  D. Classen,et al.  Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. , 1997, JAMA.

[16]  C Roseman,et al.  Workload and Environmental Factors in Hospital Medication Errors , 1995, Nursing research.

[17]  D. Bates,et al.  Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. , 1998, JAMA.

[18]  L. Goldman,et al.  Preoperative assessment of patients with known or suspected coronary disease. , 1995, The New England journal of medicine.

[19]  T. Brennan,et al.  Does Housestaff Discontinuity of Care Increase the Risk for Preventable Adverse Events? , 1994, Annals of Internal Medicine.

[20]  T. Brennan,et al.  Identifying Adverse Events Caused by Medical Care: Degree of Physician Agreement in a Retrospective Chart Review , 1996, Annals of Internal Medicine.

[21]  D. Gaba,et al.  Anesthesia crisis resource management training: teaching anesthesiologists to handle critical incidents. , 1992, Aviation, space, and environmental medicine.

[22]  T. Brennan,et al.  INCIDENCE OF ADVERSE EVENTS AND NEGLIGENCE IN HOSPITALIZED PATIENTS , 2008 .

[23]  Troyen A. Brennan,et al.  Identification of adverse events occurring during hospitalization. A cross-sectional study of litigation, quality assurance, and medical records at two teaching hospitals. , 1990, Annals of internal medicine.

[24]  Colin F. Mackenzie,et al.  SPECIAL SECTION: Task Complexity in Emergency Medical Care and Its Implications for Team Coordination , 1996, Hum. Factors.

[25]  Richard I. Cook,et al.  SPECIAL SECTION: Adapting to New Technology in the Operating Room , 1996, Hum. Factors.

[26]  J. Senders.  Theory and analysis of typical errors in a medical setting. , 1993, Hospital pharmacy.

[27]  D. L. Simms,et al.  Normal Accidents: Living with High-Risk Technologies , 1986 .

[28]  A. Egberts,et al.  Adverse drug events in hospitalized patients A comparison of doctors, nurses and patients as sources of reports , 1999, European Journal of Clinical Pharmacology.

[29]  R. Gibberd,et al.  The Quality in Australian Health Care Study , 1995, The Medical journal of Australia.

[30]  H Pohl,et al.  Medication-prescribing errors in a teaching hospital. A 9-year experience. , 1997, Archives of internal medicine.

[31]  L. Leape.  Error in medicine. , 1994, JAMA.

[32]  M R Cohen,et al.  Preventing medication errors in cancer chemotherapy. , 1996, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[33]  Page Keeton,et al.  Prosser and Keeton on the Law of Torts , 1984 .

[34]  J P Kahan,et al.  The reproducibility of a method to identify the overuse and underuse of medical procedures. , 1998, The New England journal of medicine.