Estimating preventable hospital deaths: the authors reply

We thank Dr James for offering further comments on the debate on estimating deaths due to medical error, and for his clarification of the definition used in his Journal of Patient Safety article.1 Dr James' letter reinforces the need for improved consistency, explicitness and reproducibility in measurement of medical error (and harms associated with it) that we called for in our article.2

One area where such clarity is much needed is in what Dr James describes as errors of omission, which by their nature are more difficult to detect than the slips and lapses that have traditionally been the concern of patient safety efforts. He mentions the example of β-blockers as a treatment for patients with heart failure, but this is not a straightforward example of deficient practice. While it is true that some early studies in the 1980s suggested a positive impact, β-blockers...

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