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Controversies |

Patient Safety Efforts Should Focus on Medical Injuries

Peter M. Layde, MD, MSc; Leslie A. Maas, MHS; Stephen P. Teret, JD, MPH; Karen J. Brasel, MD, MPH; Evelyn M. Kuhn, PhD; James A. Mercy, PhD; Stephen W. Hargarten, MD, MPH
JAMA. 2002;287(15):1993-1997. doi:10.1001/jama.287.15.1993.
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TThe Institute of Medicine (IOM) report To Err Is Human: Building a Safer Health System1 called for voluntary and mandatory reporting systems to identify and learn from errors in health care. That report and other recent efforts to improve patient safety have focused their attention on medical errors.2 However, patient safety also may be approached by concentrating on the injury itself.3,4 Both approaches consider the subset of patient injuries that are the result of errors (Figure 1). The error-oriented approach includes mistakes that do not harm patients such as near-misses. The injury-oriented approach includes patient harm arising from a diagnostic or therapeutic intervention, including those that are not associated with any identifiable error. The difficulty in reliably identifying medical errors, the adverse impact on patient outcomes of medical injuries regardless of whether they result from error, and the potential preventability of medical injuries not associated with error all suggest that the injury-oriented approach may be more appropriate and more productive. This article considers the benefits for patient safety of a primary focus on medical injury based on the injury prevention model, a public health approach that has proven useful in addressing other types of injuries.

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Figure 1. Relationship Between Medical Errors and Medical Injuries and Approaches to Patient Safety
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Figure 2. Haddon Phase-Factor Matrix
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Adapted from Haddon15 with permission from Lippincott Williams & Wilkins.



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