To the Editor.
—While noting that anesthesiology is the only specialty that has focused on and been successful in reducing errors in medicine, Dr Leape1 misrepresents the temporal aspects of the improvement. Specifically, he writes, "Whereas mortality from anesthesia was one in 10 000 to 20 000 just a decade or so ago, it is now estimated at less than one in 200 000," citing my technology assessment of newer approaches to patient monitoring during anesthesia.2 The improvement actually occurred over several decades, approaching the rate of one in 200 000 by the mid 1980s (Figure 1), just before standards for patient monitoring during anesthesia were promulgated by the specialty. It is doubtful that the efficacy of the anesthesia-monitoring standards can be proven because demonstrating changes in the preexisting low rates of severe adverse events (cardiac arrest and brain damage as well as death) due primarily to anesthetic
Orkin FK. Error in Medicine. JAMA. 1995;274(6):459-460. doi:10.1001/jama.1995.03530060031022