Toward Understanding Errors in Inpatient Psychiatry: A Qualitative Inquiry

Abstract

While prior research has identified the impact, nature, and causes of medical error in general medical settings, little is known about errors in inpatient psychiatry. Understanding the broad range of errors that occur in inpatient psychiatry is a critical step toward improving systems of care for a vulnerable patient population. An explorative qualitative analysis of key informant interviews identified a preliminary typology of errors and the contextual factors that precipitate them in inpatient psychiatry. The types of errors and their contextual factors fall broadly within the rubric of categories identified in medicine and surgery. However, many of the specific errors and contextual factors manifest themselves differently and are shaped by the uniqueness of the inpatient psychiatric setting and patient population. Interventions geared toward improving systems of care for psychiatric patients should draw on best practices for safety in medicine and surgery, but also be complemented with new strategies specifically tailored to the inpatient psychiatric setting.

Clinical risk management in mental health: a qualitative study of main risks and related organizational management practices

“…This encompasses the misdiagnosis of a mental illness when it was a physical illness and the misdiagnosis of psychiatric illnesses [cf. [13]. This can result in incorrect treatment (therapy, medication) that can worsen the patient’s condition.…”

“…It allows for organizing, sorting and retrieving the coded text passages. This technique for guiding the analysis of qualitative data relying on prior research had proven valuable in previous studies, for example, identifying and categorizing errors in mental health [13]. …”

“…While medication related risks, such as medication mix-up or delivery of wrong dose, are found in acute medical care and mental health [e.g. [13], specific risks, such as suicide, violence and self-harm prevail in mental health [14]. To date, an overview of the spectrum of clinical risks found in mental health and the organizational risk management practices currently applied is lacking.…”

“…This is an important step in deepening our knowledge of patient safety and in supporting psychiatric hospitals to optimize their clinical risk management and to ultimately improve the health care system, for the mentally ill [13]. …”

Adverse events in veterans affairs inpatient psychiatric units: Staff perspectives on contributing and protective factors

“…10 Exploratory interviews with key informants in the psychiatric unit at two Pennsylvania hospitals established a preliminary typology of some of the contextual factors influencing safety events, including provider communication, staff experience, stigma toward psychiatric patients, and patient medical comorbidity. 11 While these studies have contributed to our understanding of patient safety in hospital-based mental health care, what remains missing from the literature is a unified focus on how patient, provider and system factors interrelate and more importantly, how they can be appropriately considered when planning interventions to reduce patient safety events.…”