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Lucian L. Leape, MD
Harvard School of Public Health Boston, Mass

JAMA. 1995;274(6):460-461.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In Reply.

—Dr Bell and Dr Krakow note the likely effects of sleep deprivation on house officer performance. While I share their concern and agree that redesign of house officers' roles is a systems change that is long overdue, there may be perverse effects. More humane working hours also means more discontinuity in patient care, which can increase the likelihood of errors. Petersen et al have shown that preventable adverse events are twice as likely when patients are cared for by a "covering physician."¹

I agree with Dr Cunnington on the importance of differentiating between errors and nonpreventable adverse events, a distinction we have made in previous articles.^2-4 We found, however, that most injuries were avoidable. While it is certainly true that errors revealed at autopsy are sometimes unavoidable, they are errors nonetheless. If the concept of error can be divorced from the concept of blame, then autopsy-discovered . . . [Full Text PDF of this Article]

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