Thanks gwern, I guess I just didn’t see the big blue button with “Download Free PDF” (extrapolating — my patients will be dying at about a 1 in 3 rate).
Here are the important paragraphs (pgs. 27-29):
The most extensive study of adverse events is the Harvard Medical Practice Study, a study of more than 30,000 randomly selected discharges from 51 randomly selected hospitals in New York State in 1984.30 Adverse events, manifest by prolonged hospitalization or disability at the time of discharge or both, occurred in 3.7 percent of the hospitalizations. The proportion of adverse events attributable to errors (i.e., preventable adverse events) was 58 percent and the proportion of adverse events due to negligence was 27.6 percent. Although most of these adverse events gave rise to disability lasting less than six months, 13.6 percent resulted in death and 2.6 percent caused permanently disabling injuries. Drug complications were the most common type of adverse event (19 percent), followed by wound infections (14 percent) and technical complications (13 percent).[1][2][3]
The findings of the Harvard Medical Practice Study in New York have recently been corroborated by a study of adverse events in Colorado and Utah occurring in 1992.[4] This study included the review of medical records pertaining to a random sample of 15,000 discharges from a representative sample of hospitals in the two states. Adverse events occurred in 2.9 percent of hospitalizations in each state. Over four out of five of these adverse events occurred in the hospital, the remaining occurred prior to admission in physicians’ offices, patients’ homes or other non-hospital settings. The proportion of adverse events due to negligence was 29.2 percent, and the proportion of adverse events that were preventable was 53 percent. As was the case in the New York study, over 50 percent of adverse events were minor, temporary injuries. But the study in New York found that 13.6 percent of adverse events led to death, as compared with 6.6 percent in Colorado and Utah. In New York, about one in four negligent adverse events led to death, while in Colorado and Utah, death resulted in about 1 out of every 11 negligent adverse events.
Extrapolation of the results of the Colorado and Utah study to the over 33.6 million admissions to hospitals in the United States in 1997,[5] implies that at least 44,000 Americans die in hospitals each year as a result of preventable medical errors. Based on the results of the New York study, the number of deaths due to medical error may be as high as 98,000. By way of comparison, the lower estimate is greater than the number of deaths attributable to the 8th-leading cause of death.
The important takeaways:
Negligence is responsible for something like 30% of these events.
“Preventable” errors (e.g. drug complications) are responsible for something like 50%.
Interestingly, negligence (“care that fell below the standard expected of physicians in their community”[6]) was more frequent among the more severe outcomes (around 50% of the deaths). [1]
It helps to be young. “Persons 65 or older had more than double the risk of persons 16 to 44 years of age” [1]
The main thing I’m wondering is how many of these “deaths due to negligence” are actually just examples of triage. I.e.: Doctors have intuition about who is/isn’t going to make it, and they decide to forego interventions that would postpone the inevitable. I’m not a doctor, but I can imagine these kinds of intuitions are hard to convey in medical records.
But even if we choose to ignore all adverse deaths caused by negligence (=50%), we still have between 20,000 (the Colorado/Utah study[3]) and 50,000 (the New York study[1][2]) iatrogenic deaths. That’s in the range of suicide (#11) to road injuries (#8)[7]. Not good.
It’s a NAP (US federal government) report, those are always available online. Even if you didn’t know that, I had no trouble finding it through WP or GS: https://en.wikipedia.org/wiki/To_Err_Is_Human_(report) https://www.nap.edu/read/9728/chapter/1
Thanks gwern, I guess I just didn’t see the big blue button with “Download Free PDF” (extrapolating — my patients will be dying at about a 1 in 3 rate).
Here are the important paragraphs (pgs. 27-29):
The important takeaways:
Negligence is responsible for something like 30% of these events.
“Preventable” errors (e.g. drug complications) are responsible for something like 50%.
Interestingly, negligence (“care that fell below the standard expected of physicians in their community”[6]) was more frequent among the more severe outcomes (around 50% of the deaths). [1]
It helps to be young. “Persons 65 or older had more than double the risk of persons 16 to 44 years of age” [1]
The main thing I’m wondering is how many of these “deaths due to negligence” are actually just examples of triage. I.e.: Doctors have intuition about who is/isn’t going to make it, and they decide to forego interventions that would postpone the inevitable. I’m not a doctor, but I can imagine these kinds of intuitions are hard to convey in medical records.
But even if we choose to ignore all adverse deaths caused by negligence (=50%), we still have between 20,000 (the Colorado/Utah study[3]) and 50,000 (the New York study[1][2]) iatrogenic deaths. That’s in the range of suicide (#11) to road injuries (#8)[7]. Not good.
https://www.nejm.org/doi/full/10.1056/nejm199102073240604
https://www.nejm.org/doi/full/10.1056/NEJM199102073240605
https://www.nejm.org/doi/full/10.1056/nejm199107253250405
https://www.jstor.org/stable/3767190
Still looking for this one (American Hospital Association. Hospital Statistics. Chicago. 1999) [Statista](https://www.statista.com/statistics/459718/total-hospital-admission-number-in-the-us/) says 36.2 million hospital admissions in the US in 2019.
Assessed by two independent physician-reviewers looking over randomly sampled medical records.
[35k to 47k in 1997](https://ourworldindata.org/grapher/annual-number-of-deaths-by-cause?time=1997&country=~USA).