Minnesota hospitals and surgical centers reported 125 avoidable medical errors or adverse events, including 13 that led to patient deaths, during the year ended Oct. 6, 2007. Another 10 errors resulted in serious disability, the state's health department reported. Pressure ulcers were the most commonly reported errors, followed by objects left in a surgery patient and wrong-site surgery. Under a 2003 Minnesota law, hospitals, surgery centers and behavioral health hospitals must report any of 27 preventable adverse events. Findings for each facility are publicly reported.
Falls and malfunctioning products or devices were the leading cause of deaths. Medication errors and pressure ulcers were the most commonly reported events that resulted in serious disability. Rules, policies or procedures were most often identified as the root cause of errors, followed by communication breakdowns and environmental factors or equipment. Overall, the number of adverse events fell by 29 from the prior year. Read the report. (For more on this topic, see
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