Acknowledgement of “no fault” medical injury: review of patients' hospital records in New Zealand
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7380.79 (Published 11 January 2003) Cite this as: BMJ 2003;326:79All rapid responses
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Dear Sir
We are interested in the comments of Davis et al with respect to the reporting of medical errors in countries with tort law jurisdictions over medical injury [1]. In an assessment of Personal Digital Assistants in Australia, which has a tort law jurisdiction, the Geelong group observed the following [2].
“The major advantages of data entry at the point of care are that events can be recorded soon afterwards, and the incidence of given events can be rapidly tabulated with both a numerator and denominator. In our study we found an adverse incident rate of 2.5%.”
Of these 42 events, 19 had uneventful outcomes, eight had minor morbidity, 14 had major morbidity and there was one death. If the uneventful and minor morbidity outcomes are classified as “near miss” events, then of the total of 42 critical incidents reported the anaesthetic registrars recorded 64% of these when they were “near miss” events.
The implication is that with appropriate technology for the recording of critical incidents including “near miss” events anaesthetic registrars (in a tort law jurisdiction) will record as many “near miss” critical incidents as actual adverse outcome critical incidents in the hospital care of their patients. The restriction to the recording of adverse patient events may not be related to the tort law jurisdiction over medical injury but to the ability to record events at the point of care.
Steve Bolsin
Mark Colson
References
1. Davis, P., et al., Acknowledgement of "no fault" medical injury: review of patients' hospital records in New Zealand. BMJ, 2003. 326(7380): p. 79-80.
2. Bent, P., et al., Professional monitoring and critical incident reporting using personal digital assistants. MJA, 2002. 177: p. 496-499.
Competing interests:
A/Prof Bolsin & Dr Colson are directors of Personal Professional Monitoring pty ltd. The not for profit company was set up to increase patient safety through the development of novel data collection tools that facilitate monitoring and feedback of clinical performance in the medical field.
Competing interests: No competing interests
Tort does not affect medical injury rate
Given the remarkable similarity in medical injury rates between
studies undertaken in numerous countries, it is unlikely that a tort vs
non-tort system affects annotation of medical injuries in medical records.
What is of more consern is that nothing is known about medical injury
not noted in medical records. Therefore, acknowledged medical injury rates
are minimum data, not maximum.
Davis et al's study reveals that highly preventable medical injury is
the number three leading cause of death in New Zealand following vascular
disease and cancer.
It has an economic impact in New Zealand eqivalent to 4% of GDP, yet
there is no State money dedicated to reducing its impact either socially
or economically.
Competing interests:
Member of the NZ Ministry of Health Sentinel Event Project advising on repoting and management of medical error.
Competing interests: No competing interests