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December 12, 2001

Preventable Deaths From Medical Errors

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(22):2813-2814. doi:10.1001/jama.286.22.2808

To the Editor: Drs Hayward and Hofer1 document the poor reliability of physicians' retrospective judgments of medical errors. They suggest that "previous interpretations of medical error statistics are probably misleading." However, given the methodological problems of their study, we question this interpretation.

First, the sample is small. Although the study started with 4198 deaths, only 111 of them were included in the analysis. The conclusions are based on multiple reviews, but these were conducted for only 62 patients; 59 patients had only 1 review. Second, the problems were not representative. Patients with a small number of fluid, electrolyte, and drug toxicities were oversampled. In addition, the Department of Veterans Affairs hospitals tend to care for sicker patients, but there was no standardization of disease severity. Third, the magnitude of the adverse event problem appears even worse if the quality of care that led to death is taken into account. The authors reported that 10.2% of deaths rated "borderline in care"; 22.7%, "possibly preventable by optimal care"; 6.0%, "definitely preventable"; and 6.0%, "substandard"—together leading to an unacceptable 44.9% of care deemed suboptimal or worse.