Patient Safety and Medical Errors

1. Patient Safety and Medical Errors Family Medicine Clerkship New York Medical College 2003 – 2004 Joseph L. Halbach, MD, MPH New York Medical College Department of Family Medicine

2. Patient Safety and Medical Errors Today’s Discussion • Errors/Mistakes in general • Responses to mistakes • One brief description of a medical error • What responsible physicians experience after an error • Brief data on medical errors • What’s the problem • What to do as a medical student New York Medical College Department of Family Medicine

3. Patient Safety and Medical Errors Non-MedicalMistake • Think about a recent error or mistake that you made. • What was your reaction to making that mistake? New York Medical College Department of Family Medicine

4. “Jose Martinez”fromThe New York Times Magazine Patient Safety and Medical Errors New York Medical College Department of Family Medicine

5. “The emotional impact of mistakes on family physicians.” Newman 1996 Patient Safety and Medical Errors • 30 family physicians interviewed by a family physician. • Memorable mistake • Response to a hypothetical scenario in which a colleague’s decision was associated with a fatal outcome New York Medical College Department of Family Medicine

6. Patient Safety and Medical Errors • 24/30 30-50 years old • 26/30 male • 26/30 married • 27/30 white • 23/30 remembered a mistake • 5/30 unable to remember a mistake • 2/30 had never made a mistake New York Medical College Department of Family Medicine

7. Memorable mistake Patient Safety and Medical Errors • 18/23 family physicians who remembered making a mistake made their most memorable mistake post residency • Remembered mistakes occurred almost as often in their offices as in the hospital. New York Medical College Department of Family Medicine

8. Reactions Patient Safety and Medical Errors • 96% reported self doubt • 93% were disappointed in themselves • 86% blamed themselves for the mistake • 54% experienced shame • 50% experienced fear New York Medical College Department of Family Medicine

9. Support? Patient Safety and Medical Errors • In response to their mistakes, all but one physician stated a need for support. • 63% needed to talk to someone • 48% needed validation of their decision making process • 59% needed reaffirmation of their professional competency • 30% needed reassurance of self worth New York Medical College Department of Family Medicine

10. Source of support? Patient Safety and Medical Errors • 55% spouse • 33% colleague New York Medical College Department of Family Medicine

11. Hypothetical scenario Patient Safety and Medical Errors • A colleague of yours recently saw a 54-year-old man in his office who was complaining of burning epigastric and lower retrosternal chest pain without radiation or other associated symptoms about an hour after lunch. In the office, the EKG showed some unifocal PVCs and some non-specific ST-T wave changes. After evaluating his patient’s condition, your colleague recommended that he take an antacid and return to the office in one week. Later that night, the patient was taken to the ER, unconscious, in V fib. The following morning, word has gotten around about how this attending physician missed an obvious and fatal MI. On making rounds, you see your colleague at the nurse’s station. New York Medical College Department of Family Medicine

12. Patient Safety and Medical Errors • All but one family physician thought that their colleague needed support. • Nine (32%) would have offered support unconditionally • 19 (68%) would have offered support if: • He/she were a close friend or partner • He/she first solicited their support New York Medical College Department of Family Medicine

13. Epidemiology of medical errors Patient Safety and Medical Errors • Incomplete picture • 1984 Harvard Medical Practice study • 1999 Colorado/Utah study • 1999 report of the Institute of Medicine To Err Is Human New York Medical College Department of Family Medicine

14. Patient Safety and Medical Errors • IOM reports 44,000-98,000 Americans die in hospitals each year as a result of medical errors. • 8th leading cause of death (surpassing MVAs, breast cancer, AIDS). • 6% of national health care expenditures (1996). • 7000 deaths from medication errors alone (1993). New York Medical College Department of Family Medicine

15. Patient Safety and Medical Errors What’s the PROBLEM(S)? (e.g., in the Jose Martinez case) New York Medical College Department of Family Medicine

16. Patient Safety and Medical Errors What would help to PREVENT ERRORS? Are there any RULES/REGULATIONS about what we should do/have to do? New York Medical College Department of Family Medicine

17. Patient Safety and Medical Errors What to do as a medical student? - M and M on the Web www/webmm.ahrq.gov New York Medical College Department of Family Medicine

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21. Patient Safety and Medical Errors What to do as a medical student: JCAHO National Patient Safety Goals #1 Patient Identification #2 Abbreviations #3 Wrong site, wrong patient, wrong procedure New York Medical College Department of Family Medicine

22. Patient Safety and Medical Errors Summary • Mistakes happen to everyone. • Good doctors make bad mistakes. • When we make an error, we need support. • Most errors result from system problems. • Open reporting and disclosure, not “shame and blame”. • Stayed informed! New York Medical College Department of Family Medicine