BMJ quality & safety
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BMJ quality & safety · Apr 2012
Time to accelerate integration of human factors and ergonomics in patient safety.
Progress toward improving patient safety has been slow despite engagement of the health care community in improvement efforts. A potential reason for this sluggish pace is the inadequate integration of human factors and ergonomics principles and methods in these efforts. Patient safety problems are complex and rarely caused by one factor or component of a work system. ⋯ We provide examples of how human factors and ergonomics principles and methods have improved both care processes and patient outcomes. We provide five major recommendations to better integrate human factors and ergonomics in patient safety improvement efforts: build capacity among health care workers to understand human factors and ergonomics, create market forces that demand the integration of human factors and ergonomics design principles into medical technologies, increase the number of human factors and ergonomic practitioners in health care organizations, expand investments in improvement efforts informed by human factors and ergonomics, and support interdisciplinary research to improve patient safety. In conclusion, human factors and ergonomics must play a more prominent role in health care if we want to increase the pace in improving patient safety.
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BMJ quality & safety · Apr 2012
Comparative StudyAssessment of adverse events in medical care: lack of consistency between experienced teams using the global trigger tool.
Many patients are harmed as the result of healthcare. A retrospective structured record review is one way to identify adverse events (AEs). One such review approach is the global trigger tool (GTT), a consistent and well-developed method used to detect AEs. The GTT was originally intended to be used for measuring data over time within a single organisation. However, as the method spreads, it is likely that comparisons of GTT safety outcomes between hospitals will occur. ⋯ The results do not encourage the use of the GTT for making comparisons between hospitals. The use of the GTT to this end would require substantial training to achieve better agreement across reviewer teams.
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BMJ quality & safety · Apr 2012
Exploring the role of salient distracting clinical features in the emergence of diagnostic errors and the mechanisms through which reflection counteracts mistakes.
Flaws in clinical reasoning are present in most diagnostic errors and occur even when physicians have enough knowledge to solve the problem. Deliberate reflection has been shown to improve diagnoses. The sources of faulty reasoning and how reflection counteracts them remain largely unknown. ⋯ Salient features in a case tend to attract physicians' attention and may misdirect diagnostic reasoning when they turn out to be unrelated to the problem, causing errors. Reflection helps by enabling physicians to overcome the influence of distracting features. The lack of effect for students suggests that this is only possible when there is enough knowledge to recognise which features discriminate between alternative diagnoses.
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BMJ quality & safety · Apr 2012
Medical errors reported by French general practitioners in training: results of a survey and individual interviews.
French interns in general practice are, like all medical students, exposed to medical errors during their training. ⋯ Medical errors remain a sensitive subject that is not broached enough in our university but interns need to talk about their experiences with their peers to improve risk management and prevent the recurrence of new errors.
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Attributes of the organisational culture of residency training programmes may impact patient safety. Training environments are complex, composed of clinical teams, residency programmes, and clinical units. We examined the relationship between residents' perceptions of their training environment and disclosure of or apology for their worst error. ⋯ Factors in the learning environments of residents are associated with responses to medical errors. Organisational safety culture can be measured, and used to evaluate environmental attributes of clinical training that are associated with disclosure of, and apology for, medical error.