COMMENTARY

BACK TO THE FUTURE

In June 1964, while preparing to start my internship on the medical service of the Yale-New Haven Hospital, I received a welcoming letter from the chief resident advising that the new interns begin their orientation by reading a recent article, “The hazards of hospitalization” by Elihu Schimmel.1 This now classic report was the product of Schimmel’s year as chief resident at Yale in 1960–1 when he designed a research project to involve all 33 members of the internal medicine house staff. While Robert Moser had earlier coined the term “diseases of medical progress” and a previous study estimated a 5% rate of “major toxic reactions and accidents” on a university medical service, the Yale study was the first prospective assessment of these risks. Adverse events were identified from report forms that were attached each day to the front of patients’ charts and were filled out by the attending house officers. Importantly, episodes were included in the analysis if they “arose from acceptable diagnostic or therapeutic measures deliberately instituted in the hospital”, and complications “were excluded if they arose from inadvertent errors by physicians or nurses”. The startling discovery that 20% of patients admitted to the medical service had one or more complications, even in a leading teaching hospital, was told and retold many times to succeeding generations of that hospital’s house staff.

The Schimmel report, largely forgotten except by physicians who trained at Yale in the 1960s, now appears as a landmark in the measurement of the quality of care. When this paper …