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Despite Efforts, Study Finds No Decline in Medical Errors
Date:11/24/2010

By Maureen Salamon
HealthDay Reporter

WEDNESDAY, Nov. 24 (HealthDay News) -- Despite intensive efforts to improve patient safety, a six-year study at 10 North Carolina hospitals showed no decline in so-called patient "harms," which included medical errors and unavoidable mistakes.

Sorting through patients' medical records from more than 2,300 randomly selected hospital admissions, teams of reviewers found 588 instances of patient harm, which included events such as hospital-acquired infections, surgical errors and medication dosage mistakes.

While most harms were minor and temporary, 50 were life-threatening, 17 resulted in permanent problems and 14 people died, said the researchers, who selected North Carolina hospitals because the state has shown a strong commitment to patient safety. The admissions records spanned the period from January 2002 to December 2007.

Study author Dr. Christopher Landrigan said the results likely reflect what's happening nationwide. A 1999 Institute of Medicine report publicizing high medical error rates spurred many U.S. hospitals to implement safety-promoting changes, but no uniform set of guidelines exists to direct facilities which changes to tackle, he said.

"What has been done right is that regulatory agencies have begun prioritizing patient safety," said Landrigan, an assistant professor of pediatrics and medicine at Harvard Medical School. "But these efforts have largely been a patchwork of unconnected efforts and so far have not been as strong as they can be."

Slightly more than half of the errors were avoidable, Landrigan said. They were detected by investigators who scanned patients' charts for "trigger" events that suggested mistakes had occurred, such as a prescription for an anti-opioid drug that could remedy a morphine overdose.

The study, published in the Nov. 25 issue of the New England Journal of Medicine, is important because health-care professionals "really haven't had a good sense of what's going on with safety over time," said Dr. David Bates, a professor of health policy and management at the Harvard School of Public Health, where he co-directs the program in clinical effectiveness.

"It's very useful to have robust estimates of the frequency of harm over time in a relatively large sample," said Bates, who also serves as medical director of clinical and quality analysis for Partners Healthcare System in Massachusetts and is associate editor of the Journal of Patient Safety.

Like Landrigan, Dr. Jeffrey Rothschild of Brigham and Women's Hospital in Boston believes patient safety has likely improved since the study concluded three years ago.

"But lots of opportunities for improvement are still out there," said Rothschild, also an assistant professor of medicine at Harvard Medical School. "One of the challenges is gaining a really good handle on the extent of the problem."

The researchers, who were from Brigham and Women's Hospital, Stanford University Medical School and the Institute for Healthcare Improvement, pointed out that several practices proven to improve patient safety take much time and money to implement.

These practices include work-hour limits for medical staff as well as the use of electronic medical records and computerized work-order entries for prescriptions and procedures.

"It takes awhile for these improvements to happen," Landrigan said. "My suspicion is, if we go five years hence, we're going to see these improvements over time."

The research was funded by a grant from the Rx Foundation and by funds from the Institute for Healthcare Improvement.

More information

For more on patient safety, go to the U.S. National Library of Medicine .

SOURCES: Christopher Landrigan, M.D., assistant professor, pediatrics and medicine, Harvard Medical School, Division of Sleep Medicine, Brigham and Women's Hospital, Division of General Pediatrics at Children's Hospital, Boston; Jeffrey Rothschild, M.D., assistant professor, medicine, Harvard Medical School, and physician, Department of Medicine, Brigham and Women's Hospital, Boston; David Bates, M.D., chief, division of general internal medicine and primary care, Brigham and Women's Hospital, Boston, professor, medicine, Harvard Medical School; Nov. 25, 2010, New England Journal of Medicine


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