This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (172)  • Contact me when this article is cited  Related Content  • Related letters  • Related article  • Similar articles in JAMA  Topic Collections  • Quality of Care  • Quality of Care, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

Chunliu Zhan, MD, PhD; Marlene R. Miller, MD, MSc

JAMA. 2003;290:1868-1874.

Context  Although medical injuries are recognized as a major hazard in the health care system, little is known about their impact.

Objective  To assess excess length of stay, charges, and deaths attributable to medical injuries during hospitalization.

Design, Setting, and Patients  The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) were used to identify medical injuries in 7.45 million hospital discharge abstracts from 994 acute-care hospitals across 28 states in 2000 in the AHRQ Healthcare Cost and Utilization Project Nationwide Inpatient Sample database.

Main Outcome Measures  Length of stay, charges, and mortality that were recorded in hospital discharge abstracts and were attributable to medical injuries according to 18 PSIs.

Results  Excess length of stay attributable to medical injuries ranged from 0 days for injury to a neonate to 10.89 days for postoperative sepsis, excess charges ranged from $0 for obstetric trauma (without vaginal instrumentation) to $57 727 for postoperative sepsis, and excess mortality ranged from 0% for obstetric trauma to 21.96% for postoperative sepsis (P<.001). Following postoperative sepsis, the second most serious event was postoperative wound dehiscence, with 9.42 extra days in the hospital, $40 323 in excess charges, and 9.63% attributable mortality. Infection due to medical care was associated with 9.58 extra days, $38 656 in excess charges, and 4.31% attributable mortality.

Conclusion  Some injuries incurred during hospitalization pose a significant threat to patients and costs to society, but the impact of such injury is highly variable.

Author Affiliations: Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, Md (Dr Zhan); Department of Pediatrics, Johns Hopkins University, Baltimore, Md (Dr Miller).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTERS

Definitions of Medical Injuries
Mark F. Schiowitz
JAMA. 2004;291(3):303-304.
EXTRACT | FULL TEXT  

Definitions of Medical Injuries
Arnold Blank
JAMA. 2004;291(3):304.
EXTRACT | FULL TEXT  

Definitions of Medical Injuries
James B. Carr
JAMA. 2004;291(3):304.
EXTRACT | FULL TEXT  

Definitions of Medical Injuries—Reply
Chunliu Zhan and Marlene R. Miller
JAMA. 2004;291(3):304-305.
EXTRACT | FULL TEXT  

RELATED ARTICLE

Looking for Medical Injuries Where the Light Is Bright
Saul N. Weingart and Lisa I. Iezzoni
JAMA. 2003;290(14):1917-1919.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Major Bleeding, Mortality, and Efficacy of Fondaparinux in Venous Thromboembolism Prevention Trials
Eikelboom et al.
Circulation 2009;120:2006-2011.
ABSTRACT | FULL TEXT  

"Canary Measures" Among the AHRQ Patient Safety Indicators
Yu et al.
American Journal of Medical Quality 2009;24:465-473.
ABSTRACT  

Epidemiology of Anesthesia-Related Complications in Labor and Delivery, New York State, 2002-2005
Cheesman et al.
Anesth. Analg. 2009;109:1174-1181.
ABSTRACT | FULL TEXT  

Association of Resident Fatigue and Distress With Perceived Medical Errors
West et al.
JAMA 2009;302:1294-1300.
ABSTRACT | FULL TEXT  

Comparing Costs and Quality of Care at Retail Clinics With That of Other Medical Settings for 3 Common Illnesses
Mehrotra et al.
ANN INTERN MED 2009;151:321-328.
ABSTRACT | FULL TEXT  

A comparison of hospital adverse events identified by three widely used detection methods
Naessens et al.
Int J Qual Health Care 2009;21:301-307.
ABSTRACT | FULL TEXT  

Prevalence, Complications, and Hospital Charges Associated With Use of Bone-Morphogenetic Proteins in Spinal Fusion Procedures
Cahill et al.
JAMA 2009;302:58-66.
ABSTRACT | FULL TEXT  

Cost Implications of Reduced Work Hours and Workloads for Resident Physicians
Nuckols et al.
NEJM 2009;360:2202-2215.
ABSTRACT | FULL TEXT  

Medicare's Value-Based Payment Initiatives: Impact on and Implications for Improving Physician Documentation and Coding
Rosenstein et al.
American Journal of Medical Quality 2009;24:250-258.
ABSTRACT  

Excess Cost and Length of Stay Associated With Voluntary Patient Safety Event Reports in Hospitals
Paradis et al.
American Journal of Medical Quality 2009;24:53-60.
ABSTRACT  

Chronic Kidney Disease Adversely Influences Patient Safety
Seliger et al.
J. Am. Soc. Nephrol. 2008;19:2414-2419.
ABSTRACT | FULL TEXT  

Patient safety indicators for England from hospital administrative data: case-control analysis and comparison with US data
Raleigh et al.
BMJ 2008;337:a1702-a1702.
ABSTRACT | FULL TEXT  

Predicting patient complaints in hospital settings
Kline et al.
Qual Saf Health Care 2008;17:346-350.
ABSTRACT | FULL TEXT  

Enhancing CT Productivity: Strategies for Increasing Capacity
Boland
Am. J. Roentgenol. 2008;191:3-10.
ABSTRACT | FULL TEXT  

Prevention of Venous Thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Geerts et al.
Chest 2008;133:381S-453S.
ABSTRACT | FULL TEXT  

Charges and Lengths of Stay Attributable to Adverse Patient-Care Events Using Pediatric-Specific Quality Indicators: A Multicenter Study of Freestanding Children's Hospitals
Kronman et al.
Pediatrics 2008;121:e1653-e1659.
ABSTRACT | FULL TEXT  

Stochastic Frontier Analysis of Hospital Inefficiency: A Review of Empirical Issues and an Assessment of Robustness
Rosko and Mutter
Med Care Res Rev 2008;65:131-166.
ABSTRACT  

Comparing measures of patient safety for inpatient care provided to veterans within and outside the VA system in New York
Weeks et al.
Qual Saf Health Care 2008;17:58-64.
ABSTRACT | FULL TEXT  

Does antibiotic exposure increase the risk of methicillin-resistant Staphylococcus aureus (MRSA) isolation? A systematic review and meta-analysis
Tacconelli et al.
J Antimicrob Chemother 2008;61:26-38.
ABSTRACT | FULL TEXT  

Adverse events involving intravenous patient-controlled analgesia
Hankin et al.
Am J Health Syst Pharm 2007;64:1492-1499.
ABSTRACT | FULL TEXT  

Clinical Evaluation of a Flexible Fecal Incontinence Management System
Padmanabhan et al.
Am J Crit Care 2007;16:384-393.
ABSTRACT | FULL TEXT  

Emergency Department Use and Subsequent Hospitalizations Among Members of a High-Deductible Health Plan
Wharam et al.
JAMA 2007;297:1093-1102.
ABSTRACT | FULL TEXT  

Public Reporting and Pay for Performance in Hospital Quality Improvement
Lindenauer et al.
NEJM 2007;356:486-496.
ABSTRACT | FULL TEXT  

Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study.
West et al.
JAMA 2006;296:1071-1078.
ABSTRACT | FULL TEXT  

Excess mortality caused by medical injury.
Meurer et al.
Ann Fam Med 2006;4:410-416.
ABSTRACT | FULL TEXT  

Medicare Payment For Selected Adverse Events: Building The Business Case For Investing In Patient Safety
Zhan et al.
Health Aff (Millwood) 2006;25:1386-1393.
ABSTRACT | FULL TEXT  

Initial Clinical Evaluation of a Handheld Device for Detecting Retained Surgical Gauze Sponges Using Radiofrequency Identification Technology
Macario et al.
Arch Surg 2006;141:659-662.
ABSTRACT | FULL TEXT  

Medical injuries among hospitalized children.
Meurer et al.
Qual Saf Health Care 2006;15:202-207.
ABSTRACT | FULL TEXT  

Identifying risk factors for medical injury.
Guse et al.
Int J Qual Health Care 2006;18:203-210.
ABSTRACT | FULL TEXT  

Adverse outcomes in Belgian acute hospitals: retrospective analysis of the national hospital discharge dataset
Van den Heede et al.
Int J Qual Health Care 2006;18:211-219.
ABSTRACT | FULL TEXT  

Adverse Events During Medical and Surgical Hospitalizations for Persons With Schizophrenia.
Daumit et al.
Arch Gen Psychiatry 2006;63:267-272.
ABSTRACT | FULL TEXT  

Strategies for improving surgical quality--should payers reward excellence or effort?
Birkmeyer and Birkmeyer
NEJM 2006;354:864-870.
FULL TEXT  

Mandatory Reporting of Health Care-Associated Infections: Kingdon's Multiple Streams Approach.
Odom-Forren and Hahn
Policy Politics Nursing Practice 2006;7:64-72.
 

Advantages and Disadvantages of Single-Versus Multiple-Occupancy Rooms in Acute Care Environments: A Review and Analysis of the Literature
Chaudhury et al.
Environment and Behavior 2005;37:760-786.
ABSTRACT  

The Burden of Staphylococcus aureus Infections on Hospitals in the United States: An Analysis of the 2000 and 2001 Nationwide Inpatient Sample Database
Noskin et al.
Arch Intern Med 2005;165:1756-1761.
ABSTRACT | FULL TEXT  

High and Rising Health Care Costs. Part 4: Can Costs Be Controlled While Preserving Quality?
Bodenheimer and Fernandez
ANN INTERN MED 2005;143:26-31.
ABSTRACT | FULL TEXT  

Massive subcutaneous emphysema after accidental removal of an intercostal drain
Bodenham
Br J Anaesth 2005;95:110-110.
FULL TEXT  

Improving the ICU: Part 1
Garland
Chest 2005;127:2151-2164.
ABSTRACT | FULL TEXT  

Fostering Rational Regulation of Patient Safety
Mello et al.
Journal of Health Politics, Policy and Law 2005;30:375-426.
ABSTRACT  

Five Years After To Err Is Human: What Have We Learned?
Leape and Berwick
JAMA 2005;293:2384-2390.
ABSTRACT | FULL TEXT  

Patients' safety
Stryer and Clancy
BMJ 2005;330:553-554.
FULL TEXT  

Surgery for primary supratentorial brain tumors in the United States, 1988 to 2000: The effect of provider caseload and centralization of care
Barker et al.
Neuro Oncol Duke 2005;7:49-63.
ABSTRACT  

Economic Grand Rounds: Making Do With Less: The Latest Challenge for Psychiatry
Schreter
Psychiatr. Serv. 2004;55:761-763.
FULL TEXT  

How safe is the safety paradigm?
Arah and Klazinga
Qual Saf Health Care 2004;13:226-232.
ABSTRACT | FULL TEXT  

Forgive and Remember: Managing Medical Failure
Anderson
JAMA 2004;291:1775-1776.
FULL TEXT  

Definitions of Medical Injuries
Blank
JAMA 2004;291:304-304.
FULL TEXT  

Definitions of Medical Injuries
Schiowitz
JAMA 2004;291 :303-304.
FULL TEXT  

Definitions of Medical Injuries
Carr
JAMA 2004;291 :304-304.
FULL TEXT  

Excess Hospitalization Costs Attributable to Medical Injuries
Levy
AAP Grand Rounds 2004;11:7-8.
FULL TEXT  

The Impact of Nosocomial Infections
JWatch Infect. Diseases 2003;2003:5-5.
FULL TEXT  

Medical injuries in US hospitals cause more than 30 000 deaths each year
Mayor
BMJ 2003;327:887-887.
FULL TEXT  

Looking for Medical Injuries Where the Light Is Bright
Weingart and Iezzoni
JAMA 2003;290:1917-1919.
FULL TEXT