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Preventable in-hospital medical injury under the “no fault” system in New Zealand
  1. P Davis1,
  2. R Lay-Yee2,
  3. R Briant2,
  4. A Scott3
  1. 1Department of Public Health and General Practice, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand.
  2. 2School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
  3. 3Department of Statistics, University of Auckland, Auckland, New Zealand
  1. Correspondence to:
 Professor P Davis, Department of Public Health and General Practice, Christchurch School of Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand; 


Objectives: To describe the pattern of preventable in-hospital medical injury under the “no fault” system and to assess the level of serious preventable patient harm.

Design: Cross sectional survey using a two stage retrospective assessment of medical records conducted by structured implicit review.

Setting: General hospitals with over 100 beds providing acute care in New Zealand.

Participants: A sample of 6579 patients admitted in 1998 to 13 hospitals selected by stratified systematic list sample.

Main outcome measures: Occurrence, preventability, and impact of adverse events.

Results: Over 5% of admissions were associated with a preventable in-hospital event, of which nearly half had an element of systems failure. The elderly, ethnic minority groups, and particular clinical areas were at higher risk. The chances of a patient experiencing a serious preventable adverse event subsequent to hospital admission were just under 1%, a figure close to published results from comparable studies under tort. On average, these events required an additional 4 weeks in hospital. System related issues of protocol use and development, communication, and organisation, as well as requirements for consultation and education, were pre-eminent.

Conclusions: The risk of serious preventable in-hospital medical injury for patients in New Zealand, a well established “no fault” jurisdiction, is within the range reported in comparable investigations under tort.

  • medical injury
  • patient risk
  • “no fault” system
  • medical error

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  • See editorial, pp 240–1

  • Funding: Health Research Council of New Zealand.

  • Conflict of interest: none.

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