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Estimating Hospital-Related Deaths Due to Medical Error: A Perspective From Patient Advocates

Kavanagh, Kevin T. MD, MS; Saman, Daniel M. DrPH, MPH; Bartel, Rosie BS, MS; Westerman, Kim EdD, MFA

doi: 10.1097/PTS.0000000000000364
Invited Commentary

The authors present a viewpoint regarding the quality of data used in estimating the number of preventable hospital deaths in the United States. Data derived from countries with a nationalized healthcare system with well-defined and near uniform implementation of standards may not be applicable to the fragmented noncentralized delivery system found in the United States. Although U.S. studies evaluating preventable mortality have based their projections on a small sample size, it is unlikely that this observation is due to chance, because other studies evaluating adverse events, a precursor to preventable mortality, have a much larger sample size and also report an unacceptably high number of events. In addition, although these estimates involved adult and Medicare-eligible patients who may have a higher incidence of events and create a bias, but they also did not capture all events, taken into account of mortality, which occurs after hospitalization or from misdiagnoses. It is also important not to mitigate adverse events in patients whose death is imminent. Medicine does not have the moral authority to place differing values on days, weeks, or years of life. The contention that there are approximately 200,000 preventable hospital-related deaths each year in the United States is not unreasonable. Not all hospital systems in the United States make the same investment in patient safety. Recently, the Agency for Healthcare Research & Quality has demonstrated a decline in adverse events in hospitals, but until uniform implementation of safety standards takes place, our healthcare system as a whole may well lag behind other industrialized nations.

From the *Health Watch USA, Somerset, Kentucky; †Health Watch USA, Essentia Institute of Rural Health, Duluth, Minnesota; ‡Patient Advocate, Chilton, Wisconsin; and §Family Advisor, NICU, Alta Bates Medical Center, Berkeley, California.

Correspondence: Kevin T. Kavanagh, MD, MS, Health Watch USA, P.O. Box 1403, Somerset, KY, USA (e-mail:

K.K. has received partial conference attendance and meeting support from the U.S. Department of Health and Human Services, National Quality Forum, The LeapFrog Group, and Consumer Union. He has served on the Centers for Medicare and Medicaid Services' Technical Expert Panel for Hospital Acquired Conditions, recently appointed to Strategic Working Group for the Agency for Healthcare Research and Quality for quality indicators, and is an associate editor for the Journal of Patient Safety. K.K., R.B., and K.W. were recipients of a National Patient Safety Foundation grant for registration fee expenses for the 2016 National Patient Safety Foundation Conference in Scottsdale, Arizona. The others disclose no conflict of interest.

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