Incidence and types of adverse events and negligent care in Utah and Colorado

BACKGROUND. The ongoing debate on the incidence and types of iatrogenic inj uries in American hospitals has been informed primarily by the Harvard Medi cal Practice Study, which analyzed hospitalizations in New York in 1984. Th e generalizability of these findings is unknown and has been questioned by other studies. OBJECTIVE. We used methods similar to the Harvard Medical Practice Study to estimate the incidence and types of adverse events and negligent adverse e vents in Utah and Colorado in 1992. DESIGN AND SUBJECTS. We selected a representative sample of hospitals from Utah and Colorado and then randomly sampled 15,000 nonpsychiatric 1992 disc harges. Each record was screened by a trained nurse-reviewer for 1 of 18 cr iteria associated with adverse events. If greater than or equal to 1 criter ia were present, the record was reviewed by a trained physician to determin e whether an adverse event or negligent adverse event occurred and to class ify the type of adverse event. MEASURES. The measures were adverse events and negligent adverse events. RESULTS. Adverse events occurred in 2.9+/-0.2% (mean+/-SD) of hospitalizati ons in each state. In Utah, 32.6+/-4% of adverse events were due to neglige nce; in Colorado, 27.4+/-2.4%. Death occurred in 6.6+/-1.2% of adverse even ts and 8.8+/-2.5% of negligent adverse events. Operative adverse events com prised 44.9% of all adverse events; 16.9% were negligent, and 16.6% resulte d in permanent disability. Adverse drug events were the leading cause of no noperative adverse events (19.3% of all adverse events; 35.1% were negligen t, and 9.7% caused permanent disability). Most adverse events were attribut ed to surgeons (46.1%, 22.3% negligent) and internists (23.2%, 44.9% neglig ent). CONCLUSIONS, The incidence and types of adverse events in Utah and Colorado in 1992 were similar to those in New York State in 1984. Iatrogenic injury continues to be a significant public health problem. Improving systems of surgical care and drug delivery could substantially reduce the burden of ia trogenic injury.