Patient safety in America: comparison and analysis of national and Texas patient safety research.

The Institute of Medicine (IOM) report on patient safety in late 1999, To Err is Human, attracted great national attention when it announced that 44,000 to 98,000 patients die each year in American hospitals because of patient safety problems and that a patient safety crisis exists in American health care and American hospitals. The report relied heavily on a Harvard group's study of hospital care in New York in 1984 and another Harvard group's study of hospital care in Utah and Colorado in 1992. This article reviews and compares American hospital inpatient safety research and corresponding Texas hospital patient safety research. It focuses on the major patient safety research of the last two decades that led to the IOM report, and compares information from the major studies with the work of the Texas Medical Foundation (TMF). The Harvard patient safety studies that have received great national attention are compared here with a stronger, broader, and more robust database from TMF, the peer review organization for Texas. The TMF studies of 300,000 patient admissions during 3 years in more than 400 hospitals are compared with the Harvard studies of 30,000 charts in 51 hospitals in New York in 1984 and 15,000 charts in 28 hospitals in Utah and Colorado in 1992. The TMF data and a close look at the Harvard data show a positive patient safety picture that has been ignored too often in the current debate, with low rates of significant injury and death caused by any medical care or hospital care safety or negligence problems.