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Medical Errors and Medical Education
- Carlos Estrada (19 May 2000)
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Carlos Estrada
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We have an opportunity to use the momentum generated from the Institute of Medicine report on medical errors (1) and other groups (2) to improve medical education. We recently used personal examples to increase awareness of the significance of errors in medicine. We showed a videotape on errors in medicine to the graduating class of
medical students. The tape was the keynote address of the 1999 Institute
for Healthcare Improvement National Forum on Quality Improvement in Health
Care. After viewing the tape we asked the students to close their eyes to
both maintain anonymity and increase response; and to raise their hands if
they have been exposed to medical errors. We asked, Students then described, in writing, an error that resulted in death or major harm. We typed all comments and analyzed the responses. The agreement between two independent raters for the type of error was moderate (kappa = 0.55, p<0.001) (3), disagreement was resolved by consensus. We found that errors fell in five categories: decision-making, medications, procedural, system, and others. First, errors in decision making were noted in 12/62 responses (19%; 95% CI, 10% to 29%). Examples: wrong diagnosis, pregnant patient sent home after blunt abdominal trauma. Next, medication errors accounted for 18/62 responses (29%; 95% CI, 18% to 40%). Examples: prescription for Celebrex Ò instead of Celexa Ò, long acting medication crushed. The third category, procedural errors accounted for 7/62 responses (11%; 95% CI, 3% to 19%). Examples: technical error due to insufficient training, pneumothorax due to inadequate technique. Fourth, system errors accounted for 15/62 responses (24%; 95% CI, 14% to 35%). Examples: inability to obtain medical records, too much autonomy, staffing shortage. Finally, other types of errors accounted for 10/62 responses (16%; 95% CI, 7% to 25%). Examples: fear of correcting a superior, inadequate blood sampling. We further categorized their written comments as errors that resulted in death in 14.5% (9/62) (moderate agreement, kappa = 0.57, p<0.001), and we deemed errors as preventable in 69% (43/62) (fair agreement, kappa =0.38, p=0.003). How do we interpret that 45% of graduating students are aware of an incident that has resulted in major harm or death, yet 9% had first hand information? If such estimates are accurate and representative, they are astounding. However, we believe that students are talking about those errors in informal ways. Medical errors are not the product of recent news hysteria, they occur here - at home. We are committed to facing the challenges in medical education to change the culture of blame and to provide a safe forum to discuss and learn from our errors. We suspect that the reader will discover similar findings at their own institutions. References 1. Kohn LT, Corrigan JM, Donaldson MS. Eds. To Err is Human, Building a Safer Health System. Institute of Medicine. Washington, DC: National Academy Press; 1999. 2. Wu A. Medical error: the second victim. BMJ 2000; 320: 726-727. 3. Sackett DL, Haynes RB, Guyatt GH, Tugwell P. Clinical Epidemiology: A Basic Science for Clinical Medicine. 2nd ed. Boston, Mass: Little, Brown and Co; 1991. Address Correspondence:
Carlos A. Estrada MD, MS. James Carter, MD, FACS. Clyde Brooks, MD. Clinical Information and Support Office - Support Building, University Health Systems, 2100 Stantonsburg Road, Greenville, NC 27835-6028 USA Ann C. Jobe, MD, MSN. |
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