Medical errors leading to patient death are much higher than previously thought, and may be as high as 400,000 deaths a year, according to a new study in the Journal of Patient Safety.

The latest numbers are dramatically higher than those in the Institute of Medicine’s 1999 report, To Err is Human: Building A Safer Health System, which estimated that up to 98,000 people a year die because of hospital mistakes. The data for that report is based on medical record reviews from 1984 and doesn’t take into account studies published since 2008.

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