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


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


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


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


METHODS
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.
Davis
P
P
Department of Public Health and General Practice, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand. peter.davis@chmeds.ac.nz
Lay-Yee
R
R
Briant
R
R
Scott
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D035881:Compensation and Redress; D005260:Female; D006302:Health Services Research; D006779:Hospitals, Public / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007351:Insurance, Liability; D008297:Male; D008318:Malpractice / Q000191:economics* / Q000706:statistics & numerical data; D008485:Medical Audit; D019300:Medical Errors / Q000145:classification / Q000517:prevention & control / Q000706:statistics & numerical data*; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D012189:Retrospective Studies; D017751:Safety Management