A New Evidence-based Estimate of Patient Harms
REVIEW ARTICLE
A New, Evidence-based Estimate of Patient Harms
Associated with Hospital Care
John T. James, PhD
Objectives: Based on 1984 data developed from reviews of medical records of patients treated in New York hospitals, the Institute of Medicine estimated that up to 98,000 Americans die each year from medical errors. The basis of this estimate is nearly 3 decades old; herein, an updated estimate is developed from modern studies published from
2008 to 2011.
Methods: A literature review identified 4 limited studies that used primarily the Global Trigger Tool to flag specific evidence in medical records, such as medication stop orders or abnormal laboratory results, which point to an adverse event that may have harmed a patient. Ultimately, a physician must concur on the findings of an adverse event and then classify the severity of patient harm.
Results: Using a weighted average of the 4 studies, a lower limit of
210,000 deaths per year was associated with preventable harm in hospitals. Given limitations in the search capability of the Global Trigger
Tool and the incompleteness of medical records on which the Tool depends, the true number of premature deaths associated with preventable harm to patients was estimated at more than 400,000 per year. Serious harm seems to be 10- to 20-fold more common than lethal harm.
Conclusions: The epidemic of patient harm in hospitals must be taken more seriously if it is to be curtailed. Fully engaging patients and their advocates during hospital care, systematically seeking the patients’ voice in identifying harms, transparent accountability for harm, and intentional correction of root causes of harm will be necessary to accomplish this goal.
Key Words: patient harm, preventable adverse events, transparency, patient-centered care, Global Trigger Tool, medical errors
(J Patient Saf 2013;9: 122Y128)
‘‘All men make mistakes, but a good man yields when he knows his course is wrong,
and
A New, Evidence-based Estimate of Patient Harms
Associated with Hospital Care
John T. James, PhD
Objectives: Based on 1984 data developed from reviews of medical records of patients treated in New York hospitals, the Institute of Medicine estimated that up to 98,000 Americans die each year from medical errors. The basis of this estimate is nearly 3 decades old; herein, an updated estimate is developed from modern studies published from
2008 to 2011.
Methods: A literature review identified 4 limited studies that used primarily the Global Trigger Tool to flag specific evidence in medical records, such as medication stop orders or abnormal laboratory results, which point to an adverse event that may have harmed a patient. Ultimately, a physician must concur on the findings of an adverse event and then classify the severity of patient harm.
Results: Using a weighted average of the 4 studies, a lower limit of
210,000 deaths per year was associated with preventable harm in hospitals. Given limitations in the search capability of the Global Trigger
Tool and the incompleteness of medical records on which the Tool depends, the true number of premature deaths associated with preventable harm to patients was estimated at more than 400,000 per year. Serious harm seems to be 10- to 20-fold more common than lethal harm.
Conclusions: The epidemic of patient harm in hospitals must be taken more seriously if it is to be curtailed. Fully engaging patients and their advocates during hospital care, systematically seeking the patients’ voice in identifying harms, transparent accountability for harm, and intentional correction of root causes of harm will be necessary to accomplish this goal.
Key Words: patient harm, preventable adverse events, transparency, patient-centered care, Global Trigger Tool, medical errors
(J Patient Saf 2013;9: 122Y128)
‘‘All men make mistakes, but a good man yields when he knows his course is wrong,
and
References: JAMA. 2009;301:429Y431. Accessed July 12, 2012. in the system. N Engl J Med. 2011:365:486Y488. measured. Health Aff. 2011;30:581Y589. JAMA. 2012;307:2155Y2156. Cambridge MA, 2008. Available at: http://www.ihi.org/knowledge/ Pages/Tools/IHIGlobalTriggerToolforMeasuringAEs.aspx July 12, 2012. Practice Study. N Engl J Med. 1991;324:370Y376.