Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I

Article Abstract:

The number of malpractice claims has risen steadily over the past several years, and the monetary damages awarded the plaintiffs have increased as well. Those who want reform point out the inefficiencies of the legal system, both in compensating those injured and in ensuring quality care. There is very little solid evidence about the incidence of poor quality care and injury inflicted by doctors. Malpractice should be linked to quality assurance. This study of over 31,000 New York State hospital records determined the number of adverse events, defined as injuries caused by medical management, rather than the underlying disease, and the cases of negligence. Almost one out of 25 patients suffered an adverse event, about one third of which were caused by negligence. It is calculated that in 1984 there were almost 100,000 adverse events, over half caused minimal disability, and complete recovery occurred within one month. More than 13,500 led to moderate disability with recovery within six months. Permanent disability was produced in 2,550 patients, and there were 13,451 deaths. Negligence caused over 27,000 injuries, including almost 6,900 deaths and almost 900 cases of permanent and total disability. Only a very tiny fraction of legitimate malpractice suits are ever filed. When the data were analyzed according to age, people over the age of 64 were much more likely to suffer as a result of negligence. Also, certain specialties, including neurosurgery and heart and blood vessel surgery had a higher risk of adverse events, but not higher rates of negligence, which would be expected. It should also be noted that many of these patients had serious, life-threatening illnesses, and some may have requested, and received, limited care. The article discusses sources of error in the study, including the difficulty physicians have in judging whether a standard of care has been met. (Consumer Summary produced by Reliance Medical Information, Inc.)

Statistics, Negligence

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Identification of adverse events occurring during hospitalization: a cross-sectional study of litigation, quality assurance, and medical records of two teaching hospitals

Article Abstract:

Health care providers, medical institutions, private third-party payers, and the government are all interested in providing the highest level of medical care. The quality of medical care is assessed by various methods, including the review of medical records. Malpractice litigation improves medical care by deterring substandard care. However, lawyers generally believe that the medical record does not provide complete information about the quality of medical care. The usefulness of medical records in providing information about adverse events and substandard care suffered by hospitalized patients was assessed. Medical records from two metropolitan teaching hospitals were reviewed and compared with risk management and litigation files. Medical record review had a sensitivity of 80 percent for identifying adverse events and a sensitivity of 76 percent for recognizing negligent care. Undiscovered adverse events resulted in less costly malpractice claims. Twenty of 172 adverse events did not result in malpractice litigation or risk management investigation; 6 of these 20 events were due to negligent care. Quality assurance programs at the level of the clinical departments of one hospital resulted in the review of only 12 of 82 risk management files. These findings suggest that most adverse events suffered by hospitalized patients can be identified by standard methods of reviewing medical records. Assessing the quality of medical care through medical record review should be evaluated further. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Case studies, Medicine, Practice, Quality control, Medical records, Medical practice

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Hospital characteristics associated with adverse events and substandard care

Article Abstract:

Assessment of quality of care and measurement of iatrogenic (physician-caused) injury and substandard care is a relatively new concept for the health care industry. The measurements that are used, such as standardized mortality rates, are not yet well defined. Approximately 31,000 medical records from 51 hospitals in New York were analyzed to determine the epidemiology of adverse events (AEs), injuries caused by medical intervention rather than disease. The incidence of iatrogenic injuries is a better reflection of quality of care than mortality and readmission rates. Negligent AEs are injuries caused by substandard medical management, and should all be preventable. Iatrogenic injury and negligence rates varied greatly among the hospitals. University hospitals had more iatrogenic injuries, with smaller hospitals in this category showing higher rates of injury. However, these institutions had lower rates of substandard care. Rural hospitals had low rates of AEs, probably because the very ill were transferred elsewhere to undergo more complicated procedures. Negligence was also lower in for-profit hospitals. Hospitals with more than 80 percent minority patients had high rates of adverse events. It was unclear whether this was caused by payer status of the patient, understaffing, or other factors. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hospitals, Demographic aspects, Iatrogenic diseases

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