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April 17, 2002

Patient Safety Efforts Should Focus on Medical Injuries

Author Affiliations

Author Affiliations: Injury Research Center at the Medical College of Wisconsin (Drs Layde, Brasel, Kuhn, Mercy, and Hargarten, and Ms Maas), Departments of Family and Community Medicine (Dr Layde), Emergency Medicine (Drs Kuhn and Hargarten, and Ms Maas), and Surgery (Dr Brasel), Medical College of Wisconsin, Milwaukee; and School of Public Health, Johns Hopkins University, Baltimore, Md (Mr Teret).


Controversies Section Editor: Phil B. Fontanarosa, MD, Executive Deputy Editor.

JAMA. 2002;287(15):1993-1997. doi:10.1001/jama.287.15.1993

TThe Institute of Medicine (IOM) report To Err Is Human: Building a Safer Health System1 called for voluntary and mandatory reporting systems to identify and learn from errors in health care. That report and other recent efforts to improve patient safety have focused their attention on medical errors.2 However, patient safety also may be approached by concentrating on the injury itself.3,4 Both approaches consider the subset of patient injuries that are the result of errors (Figure 1). The error-oriented approach includes mistakes that do not harm patients such as near-misses. The injury-oriented approach includes patient harm arising from a diagnostic or therapeutic intervention, including those that are not associated with any identifiable error. The difficulty in reliably identifying medical errors, the adverse impact on patient outcomes of medical injuries regardless of whether they result from error, and the potential preventability of medical injuries not associated with error all suggest that the injury-oriented approach may be more appropriate and more productive. This article considers the benefits for patient safety of a primary focus on medical injury based on the injury prevention model, a public health approach that has proven useful in addressing other types of injuries.

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