CONTEXT: Studies using physician implicit review have suggested that the number of @entity204 due to medical errors in US hospitals is extremely high. However, some have questioned the validity of these estimates. OBJECTIVE: To examine the reliability of reviewer ratings of medical error and the implications of a death described as "preventable by better care" in terms of the probability of immediate and short-term survival if care had been optimal. DESIGN: Retrospective implicit review of medical records from 1995-1996. SETTING AND @entity1 : Fourteen board-certified, trained internists used a previously tested structured implicit review instrument to conduct 383 reviews of 111 @entity204 at 7 Department of Veterans Affairs medical centers, oversampling for markers previously found to be associated with high rates of preventable @entity204 . @entity1 considered terminally ill who received comfort care only were excluded. MAIN OUTCOME MEASURES: Reviewer estimates of whether @entity204 could have been prevented by optimal care (rated on a 5-point scale) and of the probability that @entity1 would have lived to discharge or for 3 months or more if care had been optimal (rated from 0%-100%). RESULTS: Similar to previous studies, almost a quarter (22.7%) of active-care @entity1 @entity204 were rated as at least possibly preventable by optimal care, with 6.0% rated as probably or definitely preventable. Interrater reliability for these ratings was also similar to previous studies (0.34 for 2 reviewers). The reviewers' estimates of the percentage of @entity1 who would have left the hospital alive had optimal care been provided was 6.0% (95% confidence interval [CI], 3.4%-8.6%). However, after considering 3-month prognosis and adjusting for the variability and skewness of reviewers' ratings, clinicians estimated that only 0.5% (95% CI, 0.3%-0.7%) of @entity1 who died would have lived 3 months or more in good cognitive health if care had been optimal, representing roughly 1 @entity1 per 10 000 admissions to the study hospitals. CONCLUSIONS: Medical errors are a major concern regardless of @entity1 ' life expectancies, but our study suggests that previous interpretations of medical error statistics are probably misleading. Our data place the estimates of preventable @entity204 in context, pointing out the limitations of this means of identifying medical errors and assessing their potential implications for @entity1 outcomes.

Estimating XXXX due to medical errors: preventability is in the eye of the reviewer.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient', 'PARTICIPANTS'] @entity204 :: ('MESH:D003643', 'Disease') :: ['hospital deaths', 'deaths']
@entity204 :: (MESH:D003643,Disease) :: ['hospital deaths']
