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Systems Analysis of Adverse Drug Events-Reply

David W. Bates, MD, MSc; David J. Cullen, MD; Lucian L. Leape, MD
JAMA. 1996;275(1):34-35. doi:10.1001/jama.1996.03530250037019.
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In Reply.  —Dr Dickey and Mr Hatlie challenge our estimates of the extent of iatrogenic injury as "sweeping and scientifically invalid" because they are based "solely" on the MPS. Unfortunately, those results were consistent with results from a 1975 California study that showed an adverse event rate of 4.2%. Both undoubtedly underestimated the extent of injury because they relied on information recorded in medical records. As every physician knows, all events are not recorded in the medical record. In addition, neither study measured adverse events in the outpatient setting. A recent study in Australia, using MPS methodology, found an adverse event rate of 16%.1We agree with Dickey and Hatlie that the health care system is safe for the vast majority of patients and that health care professionals are dedicated to preventing injuries, points we have made repeatedly to the press and public. We have never questioned the commitment


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