Incidence and types of adverse events and negligent care in Utah and Colorado.
BACKGROUND
The ongoing debate on the incidence and types of iatrogenic injuries in American hospitals has been informed primarily by the Harvard Medical Practice Study, which analyzed hospitalizations in New York in 1984. The 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 events in Utah and Colorado in 1992.


METHODS
We selected a representative sample of hospitals from Utah and Colorado and then randomly sampled 15,000 nonpsychiatric 1992 discharges. Each record was screened by a trained nurse-reviewer for 1 of 18 criteria associated with adverse events. If > or =1 criteria were present, the record was reviewed by a trained physician to determine whether an adverse event or negligent adverse event occurred and to classify the type of adverse event.


METHODS
The measures were adverse events and negligent adverse events.


RESULTS
Adverse events occurred in 2.9+/-0.2% (mean+/-SD) of hospitalizations in each state. In Utah, 32.6+/-4% of adverse events were due to negligence; in Colorado, 27.4+/-2.4%. Death occurred in 6.6+/-1.2% of adverse events and 8.8+/-2.5% of negligent adverse events. Operative adverse events comprised 44.9% of all adverse events; 16.9% were negligent, and 16.6% resulted in permanent disability. Adverse drug events were the leading cause of nonoperative adverse events (19.3% of all adverse events; 35.1% were negligent, and 9.7% caused permanent disability). Most adverse events were attributed to surgeons (46.1%, 22.3% negligent) and internists (23.2%, 44.9% negligent).


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 iatrogenic injury.
Thomas
E J
EJ
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. ethomas@heart.med.uth.tmc.edu
Studdert
D M
DM
Burstin
H R
HR
Orav
E J
EJ
Zeena
T
T
Williams
E J
EJ
Howard
K M
KM
Weiler
P C
PC
Brennan
T A
TA
D000293:Adolescent; D000328:Adult; D003120:Colorado / Q000453:epidemiology; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology* / Q000517:prevention & control; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008318:Malpractice / Q000145:classification / Q000706:statistics & numerical data*; D008485:Medical Audit; D019300:Medical Errors / Q000145:classification / Q000517:prevention & control / Q000706:statistics & numerical data*; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D010351:Patient Discharge / Q000706:statistics & numerical data; D014589:Utah / Q000453:epidemiology