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Estimating hospital deaths due to medical errors: preventability is in the eye of the reviewer

Hayward RA, Hofer TP. Estimating hospital deaths due to medical errors: preventability is in the eye of the reviewer. Journal of the American Medical Association. 2001 Jul 25;286(4):415-420.

Studies using physician implicit review have suggested that the number of deaths due to medical errors in US hospitals is extremely high. However, some have questioned the validity of these estimates.

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Interventions to enhance patient adherence to medication prescriptions: scientific review

McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to medication prescriptions: scientific review. Journal of the American Medical Association. 2002 Dec 11;288(22):2868-2879.

Current methods of improving medication adherence for chronic health problems are mostly complex, labor-intensive, and not predictably effective. The full benefits of medications cannot be realized at currently achievable levels of adherence; therefore, more studies of innovative approaches to assist patients to follow prescriptions for medications are needed.

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Incidence and preventability of adverse drug events in nursing homes

Gurwitz JH, Field TS, Avorn J, McCormick D, Jain S, Eckler M, Benser M, Edmondson AC, Bates DW. Incidence and preventability of adverse drug events in nursing homes. The American Journal of Medicine. 2000 Aug 1;109(2):87-94.

Adverse drug events, especially those that may have been preventable, are among the most serious concerns about medication use in nursing homes. We studied the incidence and preventability of adverse drug events and potential adverse drug events in nursing homes.

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Incidence and preventability of adverse drug events among older persons in the ambulatory setting

Gurwitz JH, Field TS, Harrold LR, Rothschild J, Debellis K, Seger AC, Cadoret C, Fish LS, Garber L, Kelleher M, Bates DW. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. The Journal of the American Medical Association. 2003 Mar 5;289(9):1107-1116.

Adverse drug events, especially those that may be preventable, are among the most serious concerns about medication use in older persons cared for in the ambulatory clinical setting.

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Hospital disclosure practices: Results of a national survey

Lamb RM, Studdert DM, Bohmer RM, Berwick DM, Brennan TA. Hospital disclosure practices: Results of a national survey. Health Affairs (Millwood). 2003 Mar-Apr;22(2):73-83.

In an early 2002 survey of risk managers at a nationally representative sample of hospitals, the vast majority reported that their hospital's practice was to disclose harm at least some of the time, although only one-third of hospitals actually had board-approved policies in place.

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The business case for clinical pathways and outcomes management: A case study of Children’s Hospital and Health Center of San Diego

March A. The business case for clinical pathways and outcomes management: A case study of Children’s Hospital and Health Center of San Diego. The Commonwealth Fund. March 2003.

The Children’s Hospital and Health Center of San Diego, California, USA, has significantly lowered the cost of providing care and the length of hospitalization through measurably increasing its quality outcomes. Yet, under the current business model of per diem payment, the hospital has forfeited millions of dollars in annual revenue. This study examines the per diem payment structure typical for children’s hospitals and how reducing length of stay thereby gives children’s hospitals a financial loss. (Part of a series of case studies supported by The Commonwealth Fund and published in the journal, "Health Affairs.")

 

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Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group

Lewis GP, Jick H, Slone D, Shapiro S. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. Journal of the American Medical Association. 1995 Jul 5;274(1):29-34.

To assess incidence and preventability of adverse drug events (ADEs) and potential ADEs.

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Medication safety: moving from illusion to reality

Classen D. Medication safety: moving from illusion to reality. Journal of the American Medical Association. 2003 Mar 5;289(9):1154-1156

With more sophisticated and comprehensive means to detect adverse drug events (ADEs), studies reveal that ADEs occur in 6.5% to more than 20% of hospitalized patients, and that many of these ADEs are avoidable. Tolerance for the illusion that medication safety is as good as it can be has finally begun to change.

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A broader concept of medical errors

Lee TH. A broader concept of medical errors. New England Journal of Medicine. 2002 Dec 12;347(24):1965-1967.

A look at patient safety as an integrated set of principles.

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A series on patient safety

Leape L, Epstein AM, Hamel MB. A series on patient safety. New England Journal of Medicine. 2002 Oct 17;347(16):1272-1274.

An introduction to the NEJM's series on Patient Safety.

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