medical errors james h. paxton, md, mba ilan rubinfeld, md, mba, facs henry ford hospital christine...
TRANSCRIPT
![Page 1: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/1.jpg)
PROPERTIESAllow user to leave interaction: AnytimeShow ‘Next Slide’ Button: Show alwaysCompletion Button Label: View Presentation
![Page 2: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/2.jpg)
Medical Errors
James H. Paxton, MD, MBA
Ilan Rubinfeld, MD, MBA, FACS
Henry Ford Hospital
Christine C. Toevs, MD, FACSCarilion Clinic
![Page 3: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/3.jpg)
Slide 3
“. . . even admitting to the full extent the great value of the hospital improvements in recent years, a vast deal of the suffering, and some at least of the mortality, in these establishments is avoidable.” – Florence Nightingale (1820-1910 CE)
“I would give great praise to the physician whose mistakes are small for perfect accuracy is seldom to be seen” – Hippocrates (470 - 410 BCE)
“Grant me the courage to realize my daily mistakes so that tomorrow I shall be able to see and understand in a better light what I could not comprehend in the dim light of yesterday” – Rabbi Moshe ben Maimon (aka Maimonides, 1135-1204 CE)
![Page 4: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/4.jpg)
Slide 4
“To Err Is Human…”
Alexander Pope (1688-1744 CE)
![Page 5: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/5.jpg)
Slide 5
Medical Errors - Objectives
• Terminology
• Active vs. latent errors
• Incidence
• Theories of error
• Disclosure of errors
• Legal considerations
• Conclusions
![Page 6: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/6.jpg)
Slide 6
Common Non-Medical Definitions
• Error: a misconception resulting from incorrect information (e.g., “she was quick to point out my errors”)
• Mistake: a wrong action attributable to bad judgment, ignorance, or inattention (e.g., "he made a bad mistake“)
• Erroneousness: inadvertent incorrectness
![Page 7: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/7.jpg)
Slide 7
Medical Error - Definitions
• Medical Error (ME)
– Failure of a planned action to be completed as intended or use of a wrong plan to achieve an aim
• Near Miss
– An event or situation that could have resulted in an accident, injury, or illness but did not.
![Page 8: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/8.jpg)
Slide 8
Medical Error - Categories
• A: No error, but potential for error
• B: Error caught before med reached patient
• C: Med reached patient; no harm
• D: Increased monitoring; no harm
• E: Temporary harm requiring intervention
• F: Temporary harm requiring hospitalization
• G: Permanent harm
• H: Near death
• I: Death
![Page 9: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/9.jpg)
Slide 9
Medical Error - Aliases
• Adverse event (AE)
• Adverse outcome
• Medical mishap
• Unintended consequence
• Unplanned clinical occurrence
• Untoward incident
![Page 10: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/10.jpg)
Slide 10
Adverse Event - Definition
• Adverse Event (AE)
– Injury caused by medical management resulting in measurable disability, not due to underlying illness
• Types of AEs
– Preventable = due to error
– Unpreventable
Source: To Err is Human: Building a Safer Health System. Washington, DC: Institute of Medicine, 1999.
![Page 11: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/11.jpg)
Slide 11
• Negligence– “The failure to exercise the standard of care that a reasonably
prudent person would have exercised in a similar situation.”
• Malpractice
– “An instance of negligence or incompetence on the part of a professional.”
Legal Definitions
Source: Black’s Law Dictionary. 7th ed. (1999)
![Page 12: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/12.jpg)
Slide 12
Medical Error - Types
• Slip/Lapse
– Correct intervention, performed poorly
• Mistake
– Wrong intervention, proceeds as planned
![Page 13: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/13.jpg)
Slide 13
Latent Error (Condition)
• Systemic conditions conducive to the generation of active errors
• Human errors
• Latent errors may be hidden in computers or layers of management
Source: To Err is Human: Building a Safer Health System. Washington, DC:Institute of Medicine, 1999.
![Page 14: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/14.jpg)
Slide 14
Latent Error - Examples
![Page 15: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/15.jpg)
Slide 15
Active Error (Failure)
• Error with immediate adverse consequences
• Current responses tend to focus on active errors
Source: To Err is Human: Building a Safer Health System. Washington, DC: Institute of Medicine, 1999.
![Page 16: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/16.jpg)
Slide 16
Proximate (Seminal)Cause
Latent Errors
Active Error
Active Error
Active Error
Root Cause Analysis
“Every system is perfectly designed to produce exactly the result it gets”
![Page 17: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/17.jpg)
Slide 17
Medical Error - Summary
(Active/Latent)ERROR
Slip/Lapse
Mistake
OmissionADVERSEEVENTS
PreventableAdverse Events
Negligence
Deviation from intended (correct) plan
Incorrect plan
Plan not attempted
![Page 18: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/18.jpg)
Slide 18
Medical Error - Incidence
• Estimated 44,000-98,000 patients die from medical errors annually in the US
• 8th leading cause of death in the US
• Medical errors are costly
Source: To Err is Human: Building a Safer Health System. Washington, DC: Institute of Medicine, 1999.
![Page 19: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/19.jpg)
Slide 19
Medical Error - Incidence
Harvard Medical Practice Study
• Retrospective study, (30,121 records) 51 NY hospitals
• 3.7% of all patients experienced an adverse event (AE)
• 58% of AEs preventable
• 2.6% resulted in permanent disability
• 13.6% resulted in patient death
Brennan TA et al. Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study. Qual Saf Health Care. 1991;13:145-152.
![Page 20: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/20.jpg)
Slide 20
Medical Error - Incidence
Critical Care Safety Study
• 1-year observational study (391 patients)
• 223 “serious errors” (SEs) without AEs were detected (~150/1,000 patient-days)
• 79 patients (20.2%) experienced 120 AEs (~81/1,000 patient-days)
• 11% of SEs and 13% of AEs were potentially life-threatening
• 61% of all SEs were medication errors
• 53% of all SEs involved slip/lapse; rather than knowledge deficit
Rothschild JM et al. The critical care safety study: the incidence and nature of adverse events and serious medical errors in intensive care. Crit Care Med. 2005;33:1694-1700.
![Page 21: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/21.jpg)
Slide 21
• Virginia Commonwealth University Study
– Retrospective study of all post-surgical complications over a 14-year period
– 2.7% of post-surgical patients experienced (and 0.13% of patients died from) a medical error
McGuire HH et al. Measuring and managing quality of surgery:
statistical vs incidental approaches. Arch Surg. 1992;127:733-737.
• With 97.3% accuracy, there would be:
– 54 unsafe plane landings at Chicago’s O’Hare Airport daily
– 432,000 pieces of mail lost by US Postal Service daily
– 21 million checks deducted from the wrong bank account daily
Error - Comparison
![Page 22: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/22.jpg)
Slide 22
Resident Self-Reporting
Wu AW et al. Do house officers learn from their mistakes? JAMA. 1991;265:2089-2094.
Procedural Complications (11%)
Communication (5%)
Evaluation (21%)
Errors in Diagnosis (33%)
Prescribing (29%)
![Page 23: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/23.jpg)
Slide 23
Sentinel Event - JCAHO
Definition = an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Such events are called sentinel because they signal the need for immediate investigation and response.
http://www.jointcommission.org/SentinelEvents/Statistics/
![Page 24: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/24.jpg)
Slide 24
Sentinel Event - Statistics
Source: http://www.jointcommission.org/SentinelEvents/Statistics/
![Page 25: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/25.jpg)
Slide 25
Sentinel Event - Statistics
Source: http://www.jointcommission.org/SentinelEvents/Statistics/
![Page 26: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/26.jpg)
Slide 26
Sentinel Event - Statistics
Source: http://www.jointcommission.org/SentinelEvents/Statistics/
![Page 27: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/27.jpg)
Slide 27
Sentinel Event - Statistics
Source: http://www.jointcommission.org/SentinelEvents/Statistics/
![Page 28: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/28.jpg)
Slide 28
Sources: Bates DW et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA. 1998;280:1311-1316.Gandhi TK et al. Adverse drug events in ambulatory care. N Engl J Med. 2003;348:1556-1564.
Adverse Drug Events (ADEs)
• 5.7% of all prescriptions filled include some error
• ADEs common with both inpatients & outpatients
![Page 29: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/29.jpg)
Slide 29
Medication Errors - Question
• In which stage of the medication order cycle are mistakes most likely to occur?
– Ordering the medication
– Transcribing the medication order
– Filling or dispensing the medication order
– Administering the medication
![Page 30: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/30.jpg)
Slide 30
Medication Errors - Answer
• When?
– 56% at stage of ordering
– 6% from transcribing order
– 34% at administration
• What?
– Dose (28%)
– Route (18%)
– Documentation error (14%)
– No or wrong date (12%)
– Frequency (9.4%)
– Other (18.6%)
Rx Written
Rx Transcribed
Med Dispensed
Med Administered
(Physician)
(Clinical Secretary)
(Pharmacist)
(Nurse)
![Page 31: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/31.jpg)
Slide 31
Unclear Abbreviations
Abbrev Intended Interpreted Better
µg Microgram Milligram mcg
o.d. or OD Daily Right eye Daily
TIW 3 X week TID 3 times a week
QD Daily QID Daily
or Every day
QOD Every other day QD or QID Every other day
U Units Zero units
![Page 32: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/32.jpg)
Slide 32
Theory Chains of Error
• Aviation industry
• Small slips or lapses accumulate
• Average plane crash involves 6 different errors
![Page 33: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/33.jpg)
Slide 33
Theory - “Swiss Cheese” Model
Source: Reason J. Human Error. New York: Cambridge University Press; 1990
![Page 34: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/34.jpg)
Slide 34
Theory - HFACS Framework*
* Developed for US Navy and Marine Corps (2000)
![Page 35: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/35.jpg)
Slide 35
Theory - Spectrum of Defense
Individual System
![Page 36: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/36.jpg)
Slide 36
Device Improvements
![Page 37: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/37.jpg)
Slide 37
Systemic Architecture
![Page 38: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/38.jpg)
Slide 38
AMA Code of Medical EthicsCouncil on Ethical and Judicial Affairs (1997)
• When a patient experiences significant medical complications that may have resulted from the physician’s mistake or judgment:
• the physician is ethically required to inform the patient of all the facts necessary to ensure understanding of what has occurred
• so as to enable the patient to make informed decisions regarding future medical care.
![Page 39: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/39.jpg)
Slide 39
American College of Physicians Ethics Manual (1998)
• “Physicians should disclose to patients information about procedural or judgment errors made during care if such information is material to the patient’s well-being.”
• “Although medical errors do not necessarily constitute improper, negligent, or unethical behavior, failures to disclose them are all three.”
![Page 40: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/40.jpg)
Slide 40
Disclosure - Components
Full Disclosure
• What the error was, how it contributed to the injury
• Regret that patient suffered because of error
• Reason for error
• How future recurrences will be prevented
Non-Disclosure
• Event regrettable, but “things happen”
• Vague, nebulous explanations
• No plan for prevention
![Page 41: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/41.jpg)
Slide 41
Disclosure - Barriers
• Unsure of what to report/disclose
• Fear of litigation
• Discomfort with discussing such issues
• Concern that information will harm relationship
Sources:Gallagher TH et al. JAMA. 2003;289:1001-1007.Robinson AR, et al. Arch Intern Med. 2002;162:2186-2190.Wu AW et al. JAMA. 1991;265:2089-2094.
![Page 42: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/42.jpg)
Slide 42
Disclosure - Barriers
• Emotional response to errors
• “Culture of blame”
• Lack of communication skills
Source: Leape LL. Error in medicine. JAMA. 1994;272:1851-1857.
![Page 43: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/43.jpg)
Slide 43
Disclosure - Why?
• Preserves (and often strengthens) the doctor-patient relationship
• Helps to establish a “Culture of Responsibility”
• More easily defendable from a legal viewpoint
• Gives others evidence of latent errors that may be corrected (thereby preventing future errors)
• Improves your own emotional well-being
• Can be important to your patient’s future health care
![Page 44: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/44.jpg)
Slide 44
Disclosure - How?
• Notify your professional insurer and seek assistance from those who might help you with disclosure (e.g., unit director, risk manager)
• Don't wait for the patient to ask – take the lead
• Outline plan of care to rectify harm/prevent recurrence
• Offer to get prompt second opinions when appropriate
• Offer a family meeting, with lawyers present if desired
Source: Hébert PC, et al. Bioethics for clinicians: 23. Disclosure of medical error. CMAJ. 2001;164:509-513.
![Page 45: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/45.jpg)
Slide 45
Disclosure - How?
• Always document important discussions
• Offer the option of follow-up meetings
• Be prepared for strong emotions
• Accept responsibility, but avoid attributions of blame
• Apologies and expressions of sorrow are appropriate
Source: Hébert PC, et al. Bioethics for clinicians: 23. Disclosure of medical error. CMAJ. 2001;164:509-513.
![Page 46: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/46.jpg)
Slide 46
Medical Error - Reporting
• Institutional, state, and federal health boards encourage voluntary reporting of “unanticipated outcomes”
– Evidence suggests 20% or less are reported
– Only 1/3 of patients surveyed said that a healthcare professional disclosed error or apologized for error
• Only 23 states in the US have some form of mandatory error reporting, most without protection from risk of lawsuit
Source: Blendon RJ et al. Views of practicing physicians and the public on medical errors. N Engl J Med. 2002;347:1933-1940.
![Page 47: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/47.jpg)
Slide 47
Mandatory Reporting - 2005
Source: http://www.drugtopics.com/drugtopics/article/articleDetail.jsp?id=160854
![Page 48: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/48.jpg)
Slide 48
Litigation - Statistics
• Litigation is a painful, tiresome experience for both sides
• Injuries are usually SEVERE
• >70% against emergency docs, surgeons, OB-GYNs
• Even in the “litigious” United States, odds of being sued for negligent event are less than 1 in 50
Sources: Lown B. The Lost Art of Healing; Practicing Compassion in Medicine. New York: Ballantine; 1999.Hiatt HH et al. A study of medical injury and medical malpractice. N Engl J Med. 1989;321:480-484.
![Page 49: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/49.jpg)
Slide 49
Litigation - Why?
• “Original injury is not enough”
• Prime concern: perceived lack of caring
• 3 reasons for litigation
• Lack of communication, dishonesty, patient ignored
• Over 1/3 would have abandoned litigation if provided an explanation and an apology
Source: Lown B. The Lost Art of Healing; Practicing Compassion in Medicine. New York: Ballantine; 1999.Vincent C et al. Why do people sue doctors? Lancet. 1994;343:1609-1613.
“Be plainer with me – let me know thy trespass by its true visage”
William Shakespeare, “Winter’s Tale”
![Page 50: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/50.jpg)
Slide 50
Patient injured
Claim filed
Case to trial
Court verdict
Verdict for plaintiff
Award designated
98.5%
1.5%92-87%
8-13%93%
7%81%
19%
Insurance Info Inst. Hot topics and Insr Issues. Med Mal. Apr 2003Hiatt HH et al. A study of medical injury and medical malpractice. N Engl J Med. 1989;321:480-484.
Litigation Lottery?
![Page 51: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/51.jpg)
Slide 51
Medical Malpractice Awards
Source: http://www.manhattan-institute.org/html/cjr_10.htm
![Page 52: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/52.jpg)
Slide 52
Conclusions
• Adverse event ≠ error, but many AEs are preventable
• Individual mistakes are a SYMPTOM of the problem
• Don’t perpetuate the “Culture of Blame”
• Ask for help when you need it
• Good communication is essential to ME prevention
• Disclosure is the standard of care
![Page 53: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/53.jpg)
Slide 53
Self Assessment
The following questions will provide a quick review of the important aspects of this module.
Complete Review
Skip
![Page 54: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/54.jpg)
PROPERTIESOn passing, 'Finish' button: Goes to Next SlideOn failing, 'Finish' button: Goes to Next SlideAllow user to leave quiz: At any timeUser may view slides after quiz: At any timeUser may attempt quiz: Unlimited times
![Page 55: Medical Errors James H. Paxton, MD, MBA Ilan Rubinfeld, MD, MBA, FACS Henry Ford Hospital Christine C. Toevs, MD, FACS Carilion Clinic](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649cf75503460f949c72e0/html5/thumbnails/55.jpg)
Slide 55
Conclusion
• This ends the presentation.