Transcript title

Medical Errors and Patient Safety
for Medical Educators
Joseph L. Halbach, M.D., M.P.H.
Associate Professor and Chairman
Department of Family Medicine
New York Medical College
2003 - 2004
New York Medical College/Saint Joseph’s Medical Center
Department of Family Medicine
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Medical Errors/Patient Safety
I.
Why is this topic important for Medical
Educators?
II.
What is currently being taught and who is
teaching it?
III. What do we recommend should be taught –
and how?
New York Medical College/Saint Joseph’s Medical Center
Department of Family Medicine
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Medical Errors/Patient Safety
I. Why is this topic important for
medical educators?
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Department of Family Medicine
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Medical Errors/Patient Safety
Because this topic has rapidly become
“HOT” since the “IOM Report”, embraced
by the media, government, industry, and
private groups.
But less rapidly by many physicians.
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Medical Errors/Patient Safety
Pre-1999
Hilfiker, D “Facing our Mistakes”
NEJM 1984
Harvard Medical Practice Study 1991
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Medical Errors/Patient Safety
Pre-1999
Anesthesia Patient Safety Foundation
The Mid 1990’s Incidents
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Medical Errors/Patient Safety
The IOM Report NOV 1999
(The Institute of Medicine of the National
Academy of Sciences)
44,000 – 98,000 deaths annually in US
hospitals due to error.
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Medical Errors/Patient Safety
Post – IOM:
The Patient Safety Movement
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Media
Government
Industry
Professional Associations
Joint Commission
Medical Literature
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Medical Errors/Patient Safety
GOVERNMENT
Agency for Healthcare Research and Quality
– (AHRQ)
• July 2001 “Making Healthcare Safer: A Critical
Analysis of Patient Safety Practices”
• October 2001 - $50 Million grant funding
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Medical Errors/Patient Safety
INDUSTRY
The Leapfrog Group
• Require hospitals to adopt computerized physician
order entry.
• Steer patients to hospitals/doctors with high volume
of high-risk procedures.
• Require ICUs to be staffed with critical care
specialists.
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Medical Errors/Patient Safety
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Professional Associations
National Patient Safety Foundation (AMA)
National Center for Patient Safety (VA)
Institute for Healthcare Improvement
(funding from RWJ)
National Quality Forum (NQF)
Many organizations devoted to medication
errors.
Britain, Australia, Canada and other countries
have similar powerful movements.
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Medical Errors/Patient Safety
INSTITUTIONS
Joint Commission July 2001:
New Standards for Hospitals in effect
• Leadership must create a culture of safety.
• Implementation of patient safety programs.
• Prevent errors through analysis and re-design of
vulnerable systems.
• Responsibility to disclose to patient/family if harmed
by care provided.
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Error in Medicine
JCAHO National Patient Safety Goals
2003 and 2004
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Improve Patient Identification
Improve communication among caregivers
Improve Safety of high-alert medications
Eliminate wrong-site, wrong-patient, wrong-procedure
surgery
Improve safety of Infusion Pumps
Improve clinical alarm systems
Reduce Healthcare – acquired infections
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Literature
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Number of Articles
Medical Errors/Patient Safety
Year
Articles on Medical Error/Patient Safety in Refereed Journals by year of publication (as of 4/15/02).
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Medical Errors/Patient Safety
Medical Literature
• Entire Issues devoted to the topic:
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BMJ – Feb 2000
Acad Emer Med –November 2000
J Law Med & Ethics – Fall/Winter 2001
Academic Medicine – October 2002
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Medical Errors/Patient Safety
Literature
 Medical students and residents see errors made, make
errors, do not see them discussed, and are greatly
affected by medical errors.
 Acculturation and moral development of medical
students and residents starts early.
 Future physicians need knowledge, skills and attitude to
prevent and/or handle errors.
 Residents can help identify and report errors.
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Medical Errors/Patient Safety
II. What is currently being taught and who is
teaching it?
Published Literature on educating
students and residents.
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Medical Errors/Patient Safety
Medical Schools
 We found 4 curricula Literature on Predoctoral Medical
Education described in published literature, 2 in the
US.
 We located brief references to unpublished curricula
from 16 other schools.
 Occurring in all years, mostly via lecture/discussion or
panels; many as part of the Medical Ethics or
Introduction to Clinical Medicine courses.
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Medical Errors/Patient Safety
Family Practice Residencies
No published literature was found on
educating about medical errors in
Family Practice Residencies.
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Medical Errors/Patient Safety
III. Recommendations for Teaching
• 5 Major Content Areas
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Recommended Content Areas
1. Epidemiology of medical error
(the Numbers)
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Sources of the data.
Inpatient vs outpatient
Common types of error
High risk settings
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Medical Errors/Patient Safety
Recommended Content Areas
2. Ethical, Professional, Legal Issues
and the “Culture of Medicine”
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Honestly as a core value
Obligations to patients
Threat of malpractice
“Blame and shame” culture
System errors vs bad apples
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Medical Errors/Patient Safety
Recommended Content Areas
3. How to respond to a Medical Error
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Identity and remedy error
Report
Disclose
Document
Analyze
Heal
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Medical Errors/Patient Safety
Recommended Content Areas
4. Effects on the physician
(“the second victim”)
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common reactions to making an error
coping mechanisms
need for support vs the current climate
importance of self-awareness
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Medical Errors/Patient Safety
Recommended Content Areas
5. Prevention of Medical Errors
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Design of systems to prevent or “absorb” errors
“Safety sciences” especially Human Factors
Engineering
Teamwork Training and Communication
Technology (e.g. CPOE)
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Medical Errors/Patient Safety
Teaching Methods
 Small group discussions to get at feelings about this topic
 More effective with third year students than preclinical students.
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Medical Errors/Patient Safety
Teaching Methods
 Participation of faculty, residents, students in the Institution’s
Quality and Safety Meetings.
 Role Modeling by Attendings of error reporting and disclosure
 Simulations (e.g. use of standardized patient with whom an error
must be discussed)
 Work to increase discussion of medical error and patient safety in
our specialty
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Medical Errors/Patient Safety
Components of NYMC Curriculum
 Didactic Session
 Required Readings
 Videotape/Feedback Session
Started in July 2000
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Medical Errors/Patient Safety
Feedback and other Ideas
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