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Harvard study finds no progress in avoiding negligent injury to hospital patients

Dr. Christopher P. Landrigan of Harvard Medical School is the lead author of a study published in this week's New England Journal of Medicine.  The study evaluated the patient charts of 2341 patients, from 2002 through 2007, looking for complications that indicated a likely error in treatment.  The study was not comprehensive:  it used 54 "trigger tools"  to red flag likely treatment errors and then investigate further; as a result, as noted by the head of the Joint Commission on Hospital Accreditation (a voluntary trade association that uses hospital dues to "regulate" hospital accreditation), it did not identify other, less common errors. For example, "If a hospital had performed a completely unnecessary operation, but had done it well, the study would not have uncovered it," according to Dr. Mark R. Chassin, president of the JCAH. 

Still, the study found that about 18 percent of hospitalized patients were harmed by medical care and 63 percent of these injuries were preventable.  Many patients did not suffer permanent or serious harm, but in 2.4 percent of cases, the identified mistakes caused or contributed to a patient's death.

These findings confirm data from two large previous studies, and sadly they confirm that the frequency of hospital injury has not declined in the past decade.  A Medicare study conducted in October of 2008 confirmed that 13.5 percent of Medicare patients (134,000) experienced "adverse events" during hospital stays, resulting in about 15,000 deaths during the month of the study.  A 1999 landmark study by the Institute of Medicine found similar results and estimated that about 98,000 preventable deaths occur each year as a result of errors in hospitalized medical care.

In the current study, the authors identified 588 instances of harm; that is, about 25 injuries for every 100 admissions.  Almost 43 percent of the injuries resulted in extra time in the hospital and 2.9 percent resulted in permanent injury.   About eight percent were life-threatening, and 2.4 percent caused or contributed to death.  Medication errors were the cause of 162 "never-events."  Dr. Landrigan explained that reporting of medical errors is voluntary and thus "vastly underestimates the frequency of errors and injuries."

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