Five Years After To Err Is Human

Leape, Lucian L.; Berwick, Donald M.

doi:10.1001/jama.293.19.2384

Cited by 1,080 publications

(663 citation statements)

References 29 publications

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“…Just like in the case of (the more serious) medical errors (see Insitute of Medicine (1999)) we believe coding errors are not due to "bad people" but due to "system failures" (Leape and Berwick (2005)). System interventions such as automation of certain clinical functions, complemented by training of clinical and non-clinical staff in quality management have been shown to reduce medical errors (Aron et al (Forthcoming)), and we believe that similar interventions can help with workload-induced coding errors.…”

Section: Discussionmentioning

confidence: 91%

Physician Workload and Hospital Reimbursement: Overworked Physicians Generate Less Revenue per Patient

Powell

Savin

Savva

2012

M&SOM

116

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We study the impact of physician workload on hospital reimbursement utilizing a detailed data set from the trauma department of a major urban hospital. We find that the proportion of patients assigned a "highseverity" status for reimbursement purposes, which maps, on average, to a 47.8% higher payment for the hospital, is substantially reduced as the workload of the discharging physician increases. This effect persists after we control for a number of systematic differences in patient characteristics, condition and time of discharge. Furthermore, we show that it is unlikely to be caused by selection bias or endogeneity in either discharge timing or allocation of discharges to physicians. We attribute this phenomenon to a workloadinduced reduction in diligence of paperwork execution. We estimate the associated monetary loss to be approximately 1.1% (95% Confidence Interval 0.4% − 1.9%) of the department's annual revenue.

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Section: Discussionmentioning

confidence: 91%

Physician Workload and Hospital Reimbursement: Overworked Physicians Generate Less Revenue per Patient

Powell

Savin

Savva

2012

M&SOM

116

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“…Health systems analysts have estimated that up to 98,000 avoidable deaths per year occur because of a lack of supportive safety mechanisms in pharmacy, surgery, hospital care, and outpatient care. 40,44 An analysis of medical charts for women presenting with late-stage cervical cancer within one medical system revealed that more than half of the deaths could have been avoided if the system had kept women up-to-date on routine Papanicolaou test screens. 45 The good news from the patient's perspective is that advances in biomedical science in the 20th century may have nearly doubled life expectancy; the bad news is that the healthcare system has grown complex, reactive, and potentially dangerous.…”

Section: Health Care In the Information Agementioning

confidence: 99%

eHealth Research from the User’s Perspective

Hesse¹,

Shneiderman²

2007

American Journal of Preventive Medicine

127

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Abstract:The application of information technology (IT) to issues of healthcare delivery has had a long and tortuous history in the United States. Within the field of eHealth, vanguard applications of advanced computing techniques, such as applications in artificial intelligence or expert systems, have languished in spite of a track record of scholarly publication and decisional accuracy. The problem is one of purpose, of asking the right questions for the science to solve. Historically, many computer science pioneers have been tempted to ask "what can the computer do?" New advances in eHealth are prompting developers to ask "what can people do?" How can eHealth take part in national goals for healthcare reform to empower relationships between healthcare professionals and patients, healthcare teams and families, and hospitals and communities to improve health equitably throughout the population? To do this, eHealth researchers must combine best evidence from the user sciences (human factors engineering, human-computer interaction, psychology, and usability) with best evidence in medicine to create transformational improvements in the quality of care that medicine offers. These improvements should follow recommendations from the Institute of Medicine to create a healthcare system that is (1) safe, (2) effective (evidence based), (3) patient centered, and (4) timely. Relying on the eHealth researcher's intuitive grasp of systems issues, improvements should be made with considerations of users and beneficiaries at the individual (patient-physician), group (family-staff), community, and broad environmental levels.(Am J Prev Med 2007;32(5S):S97-S103)

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“…This is the motto of the principle of nonmaleficence which is directly tied to patient safety. Primun non nocere has been widely used and debated as a guiding principle of hospital care since the publication of the classic study undertaken by the Institute of Medicine (IOM) in the United States which highlighted that approximately 98,000 people die every year in the country as a result of medical errors (5) . However, although some studies suggest that this principle is applied to nonhospital care (6) , there is apparently little adherence to this principle in the PHC sphere.…”

Section: Introductionmentioning

confidence: 99%

The role of primary care in the prevention and control of healthcare associated infections

Padoveze

Figueiredo

2014

Rev. esc. enferm. USP

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Little research has been conducted to date on the role of primary health care (PHC) in the prevention of healthcare associated infections (HCAIs). The present article is a theoretical study of the principle of primum non nocere and aims to promote reflection on the role of PHC in HCAI prevention with emphasis on practical recommendations. The indirect and direct roles of PHC in HCAI prevention are debated in light of this guiding principle. With respect to the indirect role of PHC, we discuss the issues of hospital-centrism and ambulatory care-sensitive conditions. The article outlines a number of challenges faced by health services related to PHC's direct role in HCAI prevention, highlights seven key components of HCAI prevention programmes within the PHC sphere and provides practical recommendations for HCAI control and prevention. DESCRIPTORES RESUMENEl rol de la Atención Primaria a la Salud (APS) en la prevención de Infecciones Relacionadas con la Asistencia a la Salud (IRAS) rara vez se discute en la literatura. El presente artículo tiene como meta desarrollar un estudio teórico con base en el principio Primum non nocere, trayendo a la luz una reflexión acerca del papel de la APS en la prevención de IRAS con énfasis en las recomendaciones de prácticas. Los roles indirecto y directo de la APS en la prevención de IRAS se debaten teniendo en cuenta este principio orientador. En el rol indirecto de la APS se discuten el tema del hospitalocentrismo y los internamientos por condiciones sensibles a la atención primaria. Con respecto al rol directo se apuntan los retos a superarse. Se señalan siete componentes esenciales para el desarrollo de un programa de prevención de IRAS en la APS y las respectivas recomendaciones. DESCRIPTORSInfección hospitalaria Seguridad del paciente Atención Primaria de Salud Enfermería en salud comunitaria Modelos teóricos

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Five Years After To Err Is Human

Cited by 1,080 publications

References 29 publications

Physician Workload and Hospital Reimbursement: Overworked Physicians Generate Less Revenue per Patient

Physician Workload and Hospital Reimbursement: Overworked Physicians Generate Less Revenue per Patient

eHealth Research from the User’s Perspective

The role of primary care in the prevention and control of healthcare associated infections

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