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Logo of qualsafetyQuality and Safety in Health CareCurrent TOCInstructions for authors
Qual Saf Health Care. Aug 2003; 12(4): 251–256.
PMCID: PMC1743754

Preventable in-hospital medical injury under the "no fault" system in New Zealand

Abstract

Objectives: To describe the pattern of preventable in-hospital medical injury under the "no fault" system and to assess the level of serious preventable patient harm.

Design: Cross sectional survey using a two stage retrospective assessment of medical records conducted by structured implicit review.

Setting: General hospitals with over 100 beds providing acute care in New Zealand.

Participants: A sample of 6579 patients admitted in 1998 to 13 hospitals selected by stratified systematic list sample.

Main outcome measures: Occurrence, preventability, and impact of adverse events.

Results: Over 5% of admissions were associated with a preventable in-hospital event, of which nearly half had an element of systems failure. The elderly, ethnic minority groups, and particular clinical areas were at higher risk. The chances of a patient experiencing a serious preventable adverse event subsequent to hospital admission were just under 1%, a figure close to published results from comparable studies under tort. On average, these events required an additional 4 weeks in hospital. System related issues of protocol use and development, communication, and organisation, as well as requirements for consultation and education, were pre-eminent.

Conclusions: The risk of serious preventable in-hospital medical injury for patients in New Zealand, a well established "no fault" jurisdiction, is within the range reported in comparable investigations under tort.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, Newhouse JP, Weiler PC, Hiatt HH. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991 Feb 7;324(6):370–376. [PubMed]
  • Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, Hebert L, Newhouse JP, Weiler PC, Hiatt H. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med. 1991 Feb 7;324(6):377–384. [PubMed]
  • Thomas EJ, Studdert DM, Burstin HR, Orav EJ, Zeena T, Williams EJ, Howard KM, Weiler PC, Brennan TA. Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care. 2000 Mar;38(3):261–271. [PubMed]
  • Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Newby L, Hamilton JD. The Quality in Australian Health Care Study. Med J Aust. 1995 Nov 6;163(9):458–471. [PubMed]
  • Vincent C, Neale G, Woloshynowych M. Adverse events in British hospitals: preliminary retrospective record review. BMJ. 2001 Mar 3;322(7285):517–519. [PMC free article] [PubMed]
  • Localio AR, Lawthers AG, Brennan TA, Laird NM, Hebert LE, Peterson LM, Newhouse JP, Weiler PC, Hiatt HH. Relation between malpractice claims and adverse events due to negligence. Results of the Harvard Medical Practice Study III. N Engl J Med. 1991 Jul 25;325(4):245–251. [PubMed]
  • Brennan TA, Sox CM, Burstin HR. Relation between negligent adverse events and the outcomes of medical-malpractice litigation. N Engl J Med. 1996 Dec 26;335(26):1963–1967. [PubMed]
  • Studdert DM, Thomas EJ, Burstin HR, Zbar BI, Orav EJ, Brennan TA. Negligent care and malpractice claiming behavior in Utah and Colorado. Med Care. 2000 Mar;38(3):250–260. [PubMed]
  • Gostin L. A public health approach to reducing error: medical malpractice as a barrier. JAMA. 2000 Apr 5;283(13):1742–1743. [PubMed]
  • Hiatt HH, Barnes BA, Brennan TA, Laird NM, Lawthers AG, Leape LL, Localio AR, Newhouse JP, Peterson LM, Thorpe KE, et al. A study of medical injury and medical malpractice. N Engl J Med. 1989 Aug 17;321(7):480–484. [PubMed]
  • Leape LL, Lawthers AG, Brennan TA, Johnson WG. Preventing medical injury. QRB Qual Rev Bull. 1993 May;19(5):144–149. [PubMed]
  • Thomas EJ, Brennan TA. Incidence and types of preventable adverse events in elderly patients: population based review of medical records. BMJ. 2000 Mar 18;320(7237):741–744. [PMC free article] [PubMed]
  • Runciman WB, Webb RK, Helps SC, Thomas EJ, Sexton EJ, Studdert DM, Brennan TA. A comparison of iatrogenic injury studies in Australia and the USA. II: Reviewer behaviour and quality of care. Int J Qual Health Care. 2000 Oct;12(5):379–388. [PubMed]
  • Neale G, Woloshynowych M. Retrospective case record review: a blunt instrument that needs sharpening. Qual Saf Health Care. 2003 Feb;12(1):2–3. [PMC free article] [PubMed]
  • Thomas Eric J, Petersen Laura A. Measuring errors and adverse events in health care. J Gen Intern Med. 2003 Jan;18(1):61–67. [PMC free article] [PubMed]
  • West E. Management matters: the link between hospital organisation and quality of patient care. Qual Health Care. 2001 Mar;10(1):40–48. [PMC free article] [PubMed]
  • Blendon RJ, Schoen C, Donelan K, Osborn R, DesRoches CM, Scoles K, Davis K, Binns K, Zapert K. Physicians' views on quality of care: a five-country comparison. Health Aff (Millwood) 2001 May-Jun;20(3):233–243. [PubMed]
  • Studdert DM, Brennan TA. No-fault compensation for medical injuries: the prospect for error prevention. JAMA. 2001 Jul 11;286(2):217–223. [PubMed]

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