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July 5, 1995

Above All 'Do No Harm' How Shall We Avoid Errors in Medicine?

Author Affiliations

From the Division of General Internal Medicine and Health Services Research, UCLA Center for Health Sciences, Los Angeles, Calif, and RAND, Santa Monica, Calif.

JAMA. 1995;274(1):75-76. doi:10.1001/jama.1995.03530010089040

The classic approach to quality of care evaluation has included an examination of structure, process, and outcomes and the relationship between these fundamental components of patient care. The articles by Bates et al1 and Leape et al2 in this issue of JAMA make an important contribution to quality-of-care evaluation by studying errors in medicine. They provide a conceptual framework, a clear and useful data analysis, and a systems analysis each of which contributes to our understanding of how care might be improved. By focusing on hospital-based adverse drug events (as errors in medicine), these researchers have shown that errors in care are prevalent and often preventable. They have shown that the systematic study of errors is feasible even when it relies on practicing physicians and on nurses as the informants of the errors. They have developed a taxonomy for adverse drug events that is clinically based. They make

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