ABSTRACT
In 2000, the United States' Institute of Medicine (IOM) published its seminal report on patient safety, To err is human: building a safer health system. Since then, there has been measureable progress in the reporting of adverse events and in the development of preventative patient health and safety systems, but preventable harms still occur with alarming frequency. Despite notable attention to the problem of patient safety since 2000, recent estimates suggest that medical errors and iatrogenic harm remain the third largest cause of death in US. Overall, the progress to date is simply not good enough, although there have been notable successes with particular preventable adverse events. One of the largest challenges to improvement lies with obtaining quality data on which to base an understanding of the magnitude and causes of the overall problem. The conglomeration of multiple overlapping adverse event reporting systems in the United States reflects this country's fragmented, inefficient, and inequitable health care finance and delivery system.
