Duplicate Medical Records Linked to 5x Increase in Hospital Death Risk

New research suggests that patients with duplicate medical records face substantially higher risks during hospital stays, including greater chances of intensive care and death.

Patients who have more than one medical record are far more likely to experience serious harm after being admitted to hospital, according to US research published online in the journal BMJ Quality & Safety.

The study found that these patients face a fivefold higher risk of dying in hospital and are three times more likely to need intensive care compared with patients who have a single, unified record.

Fragmented records pose serious risks

The findings have led researchers to call for stronger safeguards around data accuracy and changes to health information management policies to improve patient safety.

Duplicate records arise when one patient is assigned multiple medical record numbers within an electronic health record system. The researchers estimate that this problem affects between 5% and 10% of patients.

While duplicate records are known to disrupt continuity of care and create gaps in clinical information, the researchers note that their direct impact on patient outcomes has not been well understood.

Large-scale data reveals hidden harm

To explore this issue, the research team examined key inpatient outcomes among adults up to age 89 who were admitted to one of 12 partner hospitals in a large US health system operating across multiple regions. The study covered admissions between July 2022 and June 2023 and tracked outcomes such as length of hospital stay, readmission within 30 days, emergency procedures, admission to intensive care, and death during hospitalization.

All patients had been discharged from medical, surgical, or orthopedic care teams. During the study period, researchers reviewed 103,190 medical records and identified 73,275 patients who met the eligibility criteria. Within this group, 6086 patients were selected for analysis: 1698 had duplicate medical records, while 4388 had a single record.

The researchers deployed a statistical technique called propensity score matching, which balances out similar characteristics in two different groups of people—in this case, with and without duplicate medical records.

Duplicate charts amplify poor outcomes

Analysis of the results revealed that those with duplicate records had significantly higher odds of worse outcomes.

Inpatient death occurred in 11% of those with duplicate records compared with 2.5% of those without, and average length of stay lasted 101 hours compared with 74 hours.

Patients with duplicate charts more frequently required an emergency intervention (6% vs 5%), and they were more likely to need intensive care: 46% vs 19%. The 30-day readmission rate was also higher:12% vs 11%.

After adjusting for further potentially influential factors, such as destination and support needed at discharge, patients with duplicate records were 30% more likely to be readmitted to the hospital.

And they were 3.5 times more likely to require intensive care, and almost 5 times more likely to die while in hospital than those without duplicate records. And their hospital stay was 32% longer.

Data failures emerge as a safety issue

This is an observational study, and as such, is unable to reach definitive conclusions about cause and effect, added to which, the researchers acknowledge various limitations to their findings. These include that they weren’t able to account for the number of diagnoses and healthcare encounters. And data from a single health system may limit the generalisability of the findings, they say.

“Despite these limitations, our study highlights a concerning association within our system and underscores the importance for outside systems to investigate their own associations, determine causal pathways, and develop mechanisms to prevent duplicate chart creation and/or conduct data integration expeditiously,” they write.

To explain the associations they found, the researchers suggest that duplication might prevent providers from accessing critical information, such as allergies or medical history, that could influence the type of treatment provided.

“An additional hypothesis relates to efficiency: the presence of duplicate charts may contribute to care delays or inaccurate orders as medical teams search for information that is not readily accessible, spend extra effort navigating between multiple charts, or inadvertently overlook key details,” they add.

“These findings highlight the association between duplicate medical records and adverse patient outcomes, emphasising the need for research to understand the impacts of duplicate charts as well as targeted interventions to improve data integrity, enhance patient safety, and inform policy changes in health information management,” they conclude.

Reference: “Double trouble: a propensity-matched cohort study evaluating the associations between duplicate medical records and patient outcomes” by Gavriel Roda, Angela Keniston, Nicholas Wood and Hillary Western, 3 February 2026, BMJ Quality & Safety.
DOI: 10.1136/bmjqs-2025-019112

Funding: Clinical Effectiveness and Patient Safety Grant Program

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