An alternative strategy for studying adverse events in medical care

Andrews, Lori B.; Stocking, Carol; Krizek, Thomas J.; Gottlieb, Lawrence J.; Krizek, Claudette; Vargish, T; Siegler, Mark

doi:10.1016/s0140-6736(96)08268-2

Cited by 451 publications

(254 citation statements)

References 8 publications

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“…21 Any time an adverse event was discussed, the observers noted the event, its apparent cause, its effects, and whether anyone was blamed. Their goal was not necessarily to uncover preventable error, but to develop a catalog of adverse events, their causes, and their outcomes.…”

Section: Methods Of Detection and Reportingmentioning

confidence: 99%

Promoting Patient Safety and Preventing Medical Error in Emergency Departments

Schenkel

2000

Academic Emergency Medicine

135

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Abstract. An estimated 108,000 people die each year from potentially preventable iatrogenic injury. One in 50 hospitalized patients experiences a preventable adverse event. Up to 3% of these injuries and events take place in emergency departments. With long and detailed training, morbidity and mortality conferences, and an emphasis on practitioner responsibility, medicine has traditionally faced the challenges of medical error and patient safety through an approach focused almost exclusively on individual practitioners. Yet no matter how well trained and how careful health care providers are, individuals will make mistakes because they are human. In general medicine, the study of adverse drug events has led the way to new methods of error detection and error prevention. A combination of chart reviews, incident logs, observation, and peer solicitation has provided a quantitative tool to demonstrate the effectiveness of interventions such as computer order entry and pharmacist order review. In emergency medicine (EM), error detection has focused on subjects of high liability: missed myocardial infarctions, missed appendicitis, and misreading of radiographs. Some system-level efforts in error prevention have focused on teamwork, on strengthening communication between pharmacists and emergency physicians, on automating drug dosing and distribution, and on rationalizing shifts. This article reviews the definitions, detection, and presentation of error in medicine and EM. Based on review of the current literature, recommendations are offered to enhance the likelihood of reduction of error in EM practice.

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Section: Methods Of Detection and Reportingmentioning

confidence: 99%

Promoting Patient Safety and Preventing Medical Error in Emergency Departments

Schenkel

2000

Academic Emergency Medicine

135

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“…O aumento significativo da frequência de eventos adversos tem provocado discussões em âmbito internacional, pois, acarretam acentuado aumento da morbimortalidade, prolongam o tempo de hospitalização e elevam os custos do tratamento (4)(5) . Alguns estudos epidemiológicos apontam para uma prevalência de 20 a 46% de EAs em pacientes hospitalizados (6)(7)(8) . A incidên-cia de EAs nos países desenvolvidos varia de 2,9 a 16,5 por 100 pacientes admitidos em hospitais, provocando a morte de cerca de 100.000 pessoas nos Estados Unidos, a cada ano (9)(10)(11) .…”

Section: Introductionunclassified

Eventos adversos em Unidade de Terapia Intensiva Neonatal

Ventura¹,

Alves²,

Meneses³

2012

Rev. Bras. Enferm.

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ReSUmOEstudo observacional, prospectivo, para determinar a incidência de eventos adversos (EAs) em Unidade de Terapia Intensiva Neonatal (UTIN). Utilizou-se um "instrumento" específico, adaptado do modelo americano utilizado pela Rede Vermont-Oxford. Dos 218 recém-nascidos, 183 (84%) apresentaram EAs, correspondendo a 2,6 EA/paciente. Distúrbios da termorregulação (29%), distúrbios da glicemia (17,1%) e Infecção Relacionada à Assistência à Saúde (IRAS) de origem hospitalar (13,5%) foram os mais frequentes. Alguns EAs apresentaram associação com peso de nascimento (p < 0,05). O percentual de IRAS e a extubação não programada foi diretamente proporcional ao tempo de internamento. A incidência de EAs em UTIN é elevada entre os recém-nascidos de muito baixo peso. A qualidade da assistência torna-se primordial na elaboração das estratégias preventivas. descritores: Eventos adversos; Recém-nascido; UTI Neonatal; Assistência de enfermagem. aBStRaCt This was a prospective, observational study conducted in a neonatal intensive care unit to determine the incidence of adverse events. A specific trigger tool instrument was used, based on the one from Vermont-Oxford Network. A total of 218 neonates were followed and AEs were detected in 183 (84%) of them, with a rate of 2,6 AE/patient. Thermoregulation disorders (29%), disorders of glycemic control (17,1%) and nosocomial infections (13,5%) were the most frequent. Some AE were associated with birth weight (p<0.05). The accidental extubations and nosocomial infections were associated with hospital days. The incidence of AEs is high, especially among neonates with very low birth weight. Best practices regarding preventive strategies are necessary to improve quality of health care for these infants. Key words: Adverse events; Newborn; Neonatal Unit. ReSUmeNEstudio observacional, prospectivo para determinar la incidencia de eventos adversos (EAs) en la Unidad Neonatal de Cuidados Intensivos (UNCI). Fue utilizado un instrumento específico adaptado del modelo americano Vermont-Oxford. De los 218 recién nacidos, el 84% presentaron EA, lo que corresponde a 2,6 EA / paciente. Trastornos de la termorregulación (29%), trastornos de la glicemia (17,1%) e infección relacionada con el cuidado de la salud (IRCS) nosocomiales (13,5%) fueron los más frecuentes. Algunos presentaron asociación con el peso al nacer (p<0,05). El porcentaje de IRCS y la extubación no programada fue directamente proporcional a la duración de la estancia hospitalaria. La incidencia de EAs en la UNCI es alta entre los recién nacidos de muy bajo peso al nacer. La calidad de la asistencia es fundamental en el desarrollo de estrategias de prevención.

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“…Weiler et.al. (1993) found that only 1 claim for negligence was lodged for every 7 negligent injuries, (p. 69), the Californian study, Californian Medical Association (1977), found that only one claim for negligence was lodged for every 10 negligent injuries, and Andrews (1997) found that only 1 claim for negligence was lodged for every 15 serious adverse events. These findings are consistent with outcomes in which b > b c and so a claim is not lodged even if malpractice occurred, or for outcomes in which b is large relative to E C − k. The latter is consistent with the finding of Weiler et al, who found that nearly 80% of the patients who suffered a negligent injury, but did not lodge a tort claim, were either fully recovered from the injury within 6 months or were over 70 years of age and so their lost earnings were small (E C − b is small relative to k).…”

Section: The Model and The Datamentioning

confidence: 99%

Medical malpractice and physician liability under a negligence rule

Wright

2011

International Review of Law and Economics

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A model of costly medical malpractice claims, based on Bayes Rule, is developed to examine the effects of physicians being liable for actual damage under a negligence rule. This model is consistent with empirical evidence concerning the pattern of claims. It is shown that compensating actual damage does not provide physicians with appropriate incentives to spend the second best optimal amount of time with patients or to treat the second best optimal number of patients. As a result, too much medical malpractice occurs relative to the second best social optimum. JEL Classification Numbers: I10, K13

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An alternative strategy for studying adverse events in medical care

Cited by 451 publications

References 8 publications

Promoting Patient Safety and Preventing Medical Error in Emergency Departments

Promoting Patient Safety and Preventing Medical Error in Emergency Departments

Eventos adversos em Unidade de Terapia Intensiva Neonatal

Medical malpractice and physician liability under a negligence rule

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