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Logo of qualsafetyQuality and Safety in Health CareCurrent TOCInstructions for authors
Qual Saf Health Care. Apr 2004; 13(2): 145–152.
PMCID: PMC1743811

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

Abstract



Background: As part of an interdisciplinary study of medical injury and malpractice litigation, we estimated the incidence of adverse events, defined as injuries caused by medical management, and of the subgroup of such injuries that resulted from negligent or substandard care.

Methods: We reviewed 30 121 randomly selected records from 51 randomly selected acute care, non-psychiatric hospitals in New York State in 1984. We then developed population estimates of injuries and computed rates according to the age and sex of the patients as well as the specialties of the physicians.

Results: Adverse events occurred in 3.7% of the hospitalizations (95% confidence interval 3.2 to 4.2), and 27.6% of the adverse events were due to negligence (95% confidence interval 22.5 to 32.6). Although 70.5% of the adverse events gave rise to disability lasting less than 6 months, 2.6% caused permanently disabling injuries and 13.6% led to death. The percentage of adverse events attributable to negligence increased in the categories of more severe injuries (Wald test χ2 = 21.04, p<0.0001). Using weighted totals we estimated that among the 2 671 863 patients discharged from New York hospitals in 1984 there were 98 609 adverse events and 27 179 adverse events involving negligence. Rates of adverse events rose with age (p<0.0001). The percentage of adverse events due to negligence was markedly higher among the elderly (p<0.01). There were significant differences in rates of adverse events among categories of clinical specialties (p<0.0001), but no differences in the percentage due to negligence.

Conclusions: There is a substantial amount of injury to patients from medical management, and many injuries are the result of substandard care.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Siegel DR. An overview of medical malpractice legislation. N Y State J Med. 1986 Jul;86(7):377–391. [PubMed]
  • Robinson GO. The medical malpractice crisis of the 1970's: a retrospective. Law Contemp Probl. 1986 Spring;49(2):5–35. [PubMed]
  • Steel K, Gertman PM, Crescenzi C, Anderson J. Iatrogenic illness on a general medical service at a university hospital. N Engl J Med. 1981 Mar 12;304(11):638–642. [PubMed]
  • Couch NP, Tilney NL, Rayner AA, Moore FD. The high cost of low-frequency events: the anatomy and economics of surgical mishaps. N Engl J Med. 1981 Mar 12;304(11):634–637. [PubMed]
  • Brennan TA, Localio RJ, Laird NL. Reliability and validity of judgments concerning adverse events suffered by hospitalized patients. Med Care. 1989 Dec;27(12):1148–1158. [PubMed]
  • Brennan TA, Localio AR, Leape LL, Laird NM, Peterson L, Hiatt HH, Barnes BA. Identification of adverse events occurring during hospitalization. A cross-sectional study of litigation, quality assurance, and medical records at two teaching hospitals. Ann Intern Med. 1990 Feb 1;112(3):221–226. [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]

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