Standards: Errors in Tracking Medical Errors

By ERIC NAGOURNEY

tudies that rely solely on reviews of hospital charts to measure how often doctors make mistakes risk being in error themselves, a study released yesterday said.

Writing in The Annals of Internal Medicine, the researchers found that doctors who were asked to make conclusions based on hospital records could be wrong almost a third of the time, depending on what rules they used.

Using multiple reviewers increased the accuracy of chart review, they said.

The findings are of special interest in light of a highly publicized 1999 report by the Institute of Medicine, an arm of the National Academy of Sciences, which estimated that as many as 98,000 Americans died each year as a result of medical error. The report was based on a review of patient records.

The lead author of the new study, Dr. Eric J. Thomas of the University of Texas-Houston Medical School, and his colleagues reached their conclusions after asking doctors to conduct independent reviews of 500 medical records of patients who had been hospitalized in Utah or Colorado in 1992.

"Our findings suggest that persons and institutions interested in improving patient safety will need more reliable methods of measurement," the authors wrote.

They suggested that other approaches, including direct observation of patient care, be considered.