Safety & risk in practice.

IN MEDICINE The Harvard Medical Practice Study in the State of New York (1990) pointed out that 3.7% of a sample of 30195 hospitalized patients suffered an adverse event (AE) resulting in measurable disability. Physician experts reviewed 1133 AEs defined as unintended injuries caused by medical management. The AEs were classified as preventable, unpreventable and potentially preventable (i.e. complications reflecting a low standard of care). Nearly 70% of the AEs were found to be preventable and 6% potentially preventable. Negligence was found in 28% of the AEs. No significant age differences were found in the proportion of preventable AEs. Technical errors were the most common cause of preventable AEs (44%), followed by errors in diagnosis (17%), failures of prevention (12%) and errors in medication (10%). Negligence was more commonly an element in diagnostic failure (71 %) than in technical errors (20%). Preventable AEs showed a higher risk for prolonged disability and death than nonpreventable AEs (60% higher risk of dying). Serious medical injury with long disability or death was more often preventable than slight disability (50% of iatrogenic deaths were preventable). In the USA preventable AEs cost more than 10 billion dollars every year. The authors suggest several areas which should be targeted in hospitals to reduce iatrogenic injury. Identification and reporting methods must be vastly expanded. Hospitals need to rethink the manner in which they deal with human mistakes. Patients' falls in hospital, responsible for a substantial proportion of preventable AEs, demand more attention. The high incidence of technical errors suggests an