Medical error
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In the United States medical error is estimated to result in 44,000 to 98,000 unnecessary deaths each year and 1,000,000 excess injuries[1] (http://bmj.bmjjournals.com/cgi/content/full/320/7235/597?ijkey=190e9b6dd6e8fec4ca3c2e353f290efb8237b334&keytype2=tf_ipsecsha). It is estimated that in a typical 100 to 300 bed hospital in the United States that excess costs of $1,000,000 to $3,000,000 occur yearly attributable to prolonged stays and complications just due to medication errors.
Medical care is frequently compared adversely to aviation [2] (http://bmj.bmjjournals.com/cgi/ijlink?linkType=FULL&journalCode=bmj&resid=320/7237/781).
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Epidemiology of medical error
Medical errors are associated with inexperienced clinicians, new procedures, extremes of age, complex care and urgent care [3] (http://bmj.bmjjournals.com/cgi/content/full/320/7237/774).
Approaches to error
Traditionally, errors are attributed to mistakes made by individual who are often penalized for these mistakes. The system used to correct the errors is usually to produce new rules that add additional checks to the system to try to prevent further errors. While error rates are reduced, the errors just become less likely. Ideally the likelihood is so low that the errors are extremely unlikely. As an example, In such a system the error of free flow IV administration of heparin is approached by teaching staff how to use the IV systems and to use special care in setting the IV pump.
A newer model for improvement in medical care takes its origin from the work of W. Edwards Deming in a model of Total Quality Management. In this model, systems of care are evaluated for process issues that may contribute to errors in care. As an example, in such a system the error of free flow IV administration of Heparin is dealt with by not using IV heparin and substituting subcutaneous administration of heparin, obviating the entire problem. However, such an approach presupposes available research showing that subcutaneous heparin is as effective as IV. Thus, most systems use a combination of approaches to the problem.
The field of medicine that has taken the lead in systems approaches to safety is Anaesthesiology [4] (http://bmj.bmjjournals.com/cgi/ijlink?linkType=FULL&journalCode=bmj&resid=320/7237/785). Steps such as standardization of IV medications to 1 ml doses, national and international color coding standards, and development of improved airway support devices has made anesthesia care a model of systems improvement in care.
Examples of errors
- Wrong site surgery such as amputating the wrong limb
- Giving the wrong drug (wrong patient, wrong chemical, wrong dose, wrong time)
- Misdiagnosis
Methods to improve safety and reduce error
- voluntary reporting of errors
- root cause analysis
- systems for ensuring review by experienced or specialist practitioners [5] (http://bmj.bmjjournals.com/cgi/content/full/320/7237/737)
External Links
- Institute of Medicine's Healthcare Quality Initiative (http://www.iom.edu/focuson.asp?id=8089)
- Leapfrog Group on Patient Safety (http://www.leapfroggroup.org)
- Institute for Healthcare Improvement (http://www.ihi.org)
- Health Care Disclosure Project (http://www.healthcaredisclosure.org) Project to improve quality through public reporting of physician and hospital performance.
References
- Wu AW. Medical error: the second victim. BMJ 2000; 320: 726-727 (http://bmj.bmjjournals.com/cgi/ijlink?linkType=FULL&journalCode=bmj&resid=320/7237/726)
- Reason J. Human error: models and management. BMJ 2000; 320: 768-770 (http://bmj.bmjjournals.com/cgi/ijlink?linkType=FULL&journalCode=bmj&resid=320/7237/768)