Effective Clinical Practice, Nov/Dec 2000 highlights

December 11, 2000

Defining errors: a flaw in the definition

Reducing medical errors has become a top item for the U.S. health care system. But what exactly is a medical error? And will eliminating errors truly improve health care? The authors, who compared medical error definitions with those used to analyze industrial and transportation accidents, say medical errors should be defined in terms of failed processes that are clearly linked to adverse outcomes. Efforts to reduce errors should relate to the errors' impact on outcomes ("What is an Error?," p. 261).

Developing a culture of safety in the veterans health administration

The VHA has, over the past three years, adopted a systems approach toward assuring patient safety. Efforts include bar coding all medications and computerizing medical records. The VHA is establishing one mandatory and one voluntary system to report adverse events; the reporter remains anonymous in the voluntary system. A VHA researcher says that other health systems can learn from the VHA's progress but patient safety efforts require constant attention ("Developing a Culture of Safety in the Veterans Health Administration," p. 270).

Calculating Risk: Validity of Medical Error Numbers Questioned

Studies cited by the Institute of Medicine (IOM) in its report on medical errors substantiate that adverse events occur in 2.9 to 3.7 percent of hospital admissions. Researchers, however, question the IOM's claim that about half of these adverse events are preventable, and cast doubt on the estimate that up to 98,000 Americans die each year in the hospital because of preventable medical errors. To appropriately allocate limited resources to this problem, policy makers will need more credible estimates ("How Many Deaths Are Due to Medical Error? Getting the Number Right," p. 277).

Effective Clinical Practice is published by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM) and the Alliance of Community Health Plans. These highlights do not substitute for articles as sources of information. For articles, call 215-351-2655; or visit acponline.org/journals/ecp/index.html after December 14. This special issue includes 14 articles and essays.

American College of Physicians

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