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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 . . . [Full Text of this Article]

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Estimating Hospital Deaths Due to Medical Errors: Preventability Is in the Eye of the Reviewer
Rodney A. Hayward and Timothy P. Hofer
JAMA. 2001;286(4):415-420.
ABSTRACT | FULL TEXT