1 medical errors and patient safety for medical educators joseph l. halbach, m.d., m.p.h. associate...

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1 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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Page 1: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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Medical Errors and Patient Safetyfor 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

Page 2: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman 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

Page 3: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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I. Why is this topic important for medical educators?

Medical Errors/Patient Safety

New York Medical College/Saint Joseph’s Medical Center

Department of Family Medicine

Page 4: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman 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.

New York Medical College/Saint Joseph’s Medical Center

Department of Family Medicine

Page 5: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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Pre-1999

Hilfiker, D “Facing our Mistakes”NEJM 1984

Harvard Medical Practice Study 1991

Medical Errors/Patient Safety

New York Medical College/Saint Joseph’s Medical Center

Department of Family Medicine

Page 6: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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Medical Errors/Patient Safety

Pre-1999

Anesthesia Patient Safety Foundation

The Mid 1990’s Incidents

New York Medical College/Saint Joseph’s Medical Center

Department of Family Medicine

Page 7: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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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.

Medical Errors/Patient Safety

New York Medical College/Saint Joseph’s Medical Center

Department of Family Medicine

Page 8: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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Post – IOM:

The Patient Safety Movement• Media• Government• Industry• Professional Associations• Joint Commission• Medical Literature

Medical Errors/Patient Safety

New York Medical College/Saint Joseph’s Medical Center

Department of Family Medicine

Page 9: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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GOVERNMENTAgency for Healthcare Research and

Quality – (AHRQ)

• July 2001 “Making Healthcare Safer: A Critical Analysis of Patient Safety Practices”

• October 2001 - $50 Million grant funding

Medical Errors/Patient Safety

New York Medical College/Saint Joseph’s Medical Center

Department of Family Medicine

Page 10: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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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.

Medical Errors/Patient Safety

New York Medical College/Saint Joseph’s Medical Center

Department of Family Medicine

Page 11: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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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.

Medical Errors/Patient Safety

New York Medical College/Saint Joseph’s Medical Center

Department of Family Medicine

Page 12: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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INSTITUTIONSJoint 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.

Medical Errors/Patient Safety

New York Medical College/Saint Joseph’s Medical Center

Department of Family Medicine

Page 13: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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JCAHO National Patient Safety Goals 2003 and 2004

1. Improve Patient Identification2. Improve communication among caregivers3. Improve Safety of high-alert medications4. Eliminate wrong-site, wrong-patient, wrong-

procedure surgery5. Improve safety of Infusion Pumps6. Improve clinical alarm systems7. Reduce Healthcare – acquired infections

Error in Medicine

New York Medical College

Department of Family Medicine

Page 14: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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Medical Errors/Patient Safety

Literature

New York Medical College/Saint Joseph’s Medical Center

Department of Family Medicine

05

101520

253035

404550

5560

Year

Nu

mb

er

of

Art

icle

s

Articles on Medical Error/Patient Safety in Refereed Journals by year of publication (as of 4/15/02).

Page 15: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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Medical Literature

• Entire Issues devoted to the topic:- BMJ – Feb 2000- Acad Emer Med –November 2000 - J Law Med & Ethics – Fall/Winter 2001 - Academic Medicine – October 2002

Medical Errors/Patient Safety

New York Medical College/Saint Joseph’s Medical Center

Department of Family Medicine

Page 16: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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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.

Medical Errors/Patient SafetyLiterature

New York Medical College/Saint Joseph’s Medical Center

Department of Family Medicine

Page 17: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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II. What is currently being taught and who is teaching it?

Published Literature on educating students and residents.

Medical Errors/Patient Safety

New York Medical College/Saint Joseph’s Medical Center

Department of Family Medicine

Page 18: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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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.

Medical Errors/Patient SafetyMedical Schools

New York Medical College/Saint Joseph’s Medical Center

Department of Family Medicine

Page 19: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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No published literature was found on educating about medical

errors in Family Practice Residencies.

Medical Errors/Patient SafetyFamily Practice Residencies

New York Medical College/Saint Joseph’s Medical Center

Department of Family Medicine

Page 20: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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Medical Errors/Patient Safety

III. Recommendations for Teaching

• 5 Major Content Areas

New York Medical College/Saint Joseph’s Medical Center

Department of Family Medicine

Page 21: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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Medical Errors/Patient Safety

Recommended Content Areas

1. Epidemiology of medical error(the Numbers)

- Sources of the data.- Inpatient vs outpatient- Common types of error- High risk settings

New York Medical College/Saint Joseph’s Medical Center

Department of Family Medicine

Page 22: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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Medical Errors/Patient Safety

Recommended Content Areas

2. Ethical, Professional, Legal Issuesand the “Culture of Medicine”

- Honestly as a core value- Obligations to patients- Threat of malpractice- “Blame and shame” culture- System errors vs bad apples

New York Medical College/Saint Joseph’s Medical Center

Department of Family Medicine

Page 23: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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Medical Errors/Patient Safety

Recommended Content Areas

3. How to respond to a Medical Error- Identity and remedy error- Report - Disclose- Document- Analyze- Heal

New York Medical College/Saint Joseph’s Medical Center

Department of Family Medicine

Page 24: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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Medical Errors/Patient Safety

Recommended Content Areas

4. Effects on the physician (“the second victim”)

- common reactions to making an error- coping mechanisms- need for support vs the current climate- importance of self-awareness

New York Medical College/Saint Joseph’s Medical Center

Department of Family Medicine

Page 25: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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Recommended Content Areas

5. Prevention of Medical Errors- Design of systems to prevent or “absorb”

errors- “Safety sciences” especially Human Factors

Engineering- Teamwork Training and Communication- Technology (e.g. CPOE)

Medical Errors/Patient Safety

New York Medical College/Saint Joseph’s Medical Center

Department of Family Medicine

Page 26: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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Teaching Methods

Small group discussions to get at feelings about this topic

More effective with third year students than preclinical students.

Medical Errors/Patient Safety

New York Medical College/Saint Joseph’s Medical Center

Department of Family Medicine

Page 27: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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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

Medical Errors/Patient Safety

Page 28: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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Components of NYMC Curriculum

Didactic Session

Required Readings

Videotape/Feedback Session

Started in July 2000

Medical Errors/Patient Safety

New York Medical College/Saint Joseph’s Medical Center

Department of Family Medicine

Page 29: 1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine

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Feedback and other Ideas

Medical Errors/Patient Safety

New York Medical College/Saint Joseph’s Medical Center

Department of Family Medicine