The number of adverse health events reported in Minnesota’s hospitals has increased slightly, the smallest increase since the start of the COVID-19 pandemic, according to the Minnesota Department of Health’s 2025 report.
From Oct. 7, 2023, to Oct. 6, 2024, Minnesota’s hospitals and ambulatory surgical centers reported 624 adverse health events, or AHEs. That is up from the 610 reported in the previous year, though the report notes that the number of surgeries and procedures performed in the state also increased.
Minnesota has reported more adverse health events since the onset of the COVID-19 pandemic; in report years 2015 through 2020, the state averaged between 300 and 400 events per year.
“We are glad to see the rate of increase in the number of adverse health events beginning to slow,” said Minnesota Commissioner of Health Dr. Brooke Cunningham. “Thankfully, these types of patient harms continue to be rare when viewed against overall volume. However, we believe many, if not most, of these events are preventable and we are committed to working with providers through education and analysis to advocate for patient safety.”
In Minnesota, hospitals (federal facilities excluded) and surgical centers are required to report 29 types of “often preventable errors that could lead to serious injury or death,” per MDH. Those events include medication errors, wrong-site surgery and physical assaults against patients or staff that result in serious injury or death.
Falls and pressure ulcers, also known as bed sores, are the two most common AHEs reported in Minnesota.
In this report year, the number of wrong-site and wrong-surgery events increased, while medication errors dropped by 44% over the previous year.
In Rochester, Mayo Clinic Hospital reported 84 AHEs during the report year, a 58.5% increase from the 53 events in last year’s report. No deaths occurred due to these events, but 28 resulted in serious injury. More than half (47) of Mayo Clinic Hospital’s AHEs were stage 3, 4 or unstageable pressure ulcers.
Additionally, there were 10 falls that resulted in serious injury, and 12 surgical AHEs: six wrong procedure events and six instances of “retention of a foreign object in a patient after surgery.”
In its press release, MDH said a “portion” of the AHEs recorded in 2024 could be attributed to patients’ longer stays in the hospital.
“The high level of lengths of stay can stem from things like increased patient complexity due to delayed care, Minnesota’s aging population, systemic issues with discharge delays and limited bed availability at the next level of care due to continued workforce challenges,” MDH said.
“We are seeing higher acuity patients that need longer lengths of stay to meet their needs,” added Jennifer Schoenecker, associate vice president of quality and safety at the Minnesota Hospital Association. “We’re also seeing that it can be challenging to find the appropriate discharge placement when our patients are ready to leave our hospitals and health systems.”
More acute medical needs could also be a factor in the 8.5% increase in procedures and surgeries performed year-over-year.
“It could be some catch-up from previous COVID years where some of those procedures may have been postponed,” Schoenecker said. “And it could be due to just the overall acuity and complexity of the patients we’re serving now.”
To bring the number of AHEs down to pre-pandemic levels, Schoenecker said an emphasis on patient safety needs to continue.
“There’s a lot we learn from the events that are reported,” Schoenecker said. “We want to continue to analyze those events, learn and then spread those learnings throughout the state. … Just continuing that commitment to a culture of safety.”
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