Temporal Trends in Rates of Patient Harm Resulting from Medical Care
Open accessAbstract
BACKGROUND: In the 10 years since publication of the Institute of Medicine's report To Err Is Human, extensive efforts have been undertaken to improve patient safety. The success of these efforts remains unclear. METHODS: We conducted a retrospective study of a stratified random sample of 10 hospitals in North Carolina. A total of 100 admissions per quarter from January 2002 through December 2007 were reviewed in random order by teams of nurse reviewers both within the hospitals (internal reviewers) and outside the hospitals (external reviewers) with the use of the Institute for Healthcare Improvement's Global Trigger Tool for Measuring Adverse Events. Suspected harms that were identified on initial review were evaluated by two independent physician reviewers. We evaluated changes in the rates of harm, using a random-effects Poisson regression model with adjustment for hospital-level clustering, demographic characteristics of patients, hospital service, and high-risk conditions. RESULTS: Among 2341 admissions, internal reviewers identified 588 harms (25.1 harms per 100 admissions; 95% confidence interval [CI], 23.1 to 27.2) [corrected]. Multivariate analyses of harms identified by internal reviewers showed no significant changes in the overall rate of harms per 1000 patient-days (reduction factor, 0.99 per year; 95% CI, 0.94 to 1.04; P=0.61) or the rate of preventable harms. There was a reduction in preventable harms identified by external reviewers that did not reach statistical significance (reduction factor, 0.92; 95% CI, 0.85 to 1.00; P=0.06), with no significant change in the overall rate of harms (reduction factor, 0.98; 95% CI, 0.93 to 1.04; P=0.47). CONCLUSIONS: In a study of 10 North Carolina hospitals, we found that harms remain common, with little evidence of widespread improvement. Further efforts are needed to translate effective safety interventions into routine practice and to monitor health care safety over time. (Funded by the Rx Foundation.).
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Most studies have not found temporal reductions in the overall rate of harm attributable to medical care over the time period under study that could explain the results.
“While some reductions in the rate of medical errors may be attributable to secular trends, most studies have not found temporal reductions in the overall rate of harm attributable to medical care over the time period under study that could explain our results.40–43”
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- Authors
- Landrigan, C. P., Parry, G. J., Bones, C. B., Hackbarth, A. D., Goldmann, D. A., & Sharek, P. J.
- Affiliations
- Brigham and Women's Hospital (US)
- Boston Children's Hospital (US)
- Institute for Healthcare Improvement (US)
- RAND Corporation (US)
- Lucile Packard Children's Hospital (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2010-11-25
- Volume
- 363
- Issue
- 22
- Pages
- 2124-2134
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2124717344
- Cited by
- 1,144
- References
- 29
- Citations by year
- 2026: 12 · 2025: 31 · 2024: 30 · 2023: 30 · 2022: 37 · 2021: 58 · 2020: 59 · 2019: 97 · 2018: 73 · 2017: 84 · 2016: 75 · 2015: 104 · 2014: 118 · 2013: 126 · 2012: 101
- FWCI
- 157.56
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Battelle
- Topics
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Keywords
- patient harm, medical errors, patient safety, temporal trends, preventable harm, adverse events, Global Trigger Tool, hospitalization, To Err Is Human, safety interventions, external peer review
- MeSH terms
- Hospitals, Humans, North Carolina, Retrospective Studies, Multivariate Analysis, Medical Errors, Risk Adjustment
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