1 medical errors and patient safety for medical educators joseph l. halbach, m.d., m.p.h. associate...
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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
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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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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Medical Errors/Patient Safety
Literature
New York Medical College/Saint Joseph’s Medical Center
Department of Family Medicine
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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).
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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