HealthcarePapers
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Review Case Reports
Making patients safer! Reducing error in Canadian healthcare.
Media reports of adverse events experienced by patients raise questions about whether these are isolated exceptions or part of a larger problem. There is no reliable Canadian data on medical error; but there is little reason to expect that the situation differs markedly from Australia or the United States which have rigorously studied the problem. Research in Australia has concluded that as many as 16% of hospital patients are injured as a result of their treatment. ⋯ These cultures will require a new emphasis on teamwork, a continual focus on redesigning care systems, particularly in high risk areas such as operating rooms, intensive care units and emergency rooms. These are not easy tasks and will require investments in new equipment and new skills. These steps are essential if we are to maintain public confidence in healthcare.
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Clinicians must celebrate and study medical errors. The dark culture of blame must be replaced by a scholarly culture of safety. This commentary presents six cases that show what we can learn from errors. ⋯ Clinicians will find it difficult to undertake major safety initiatives given the existing constraints on time and energy. Although clinicians can identify the safety problems,there must also be a commitment to understand safety problems and make improvements. It is strongly recommended that hospitals train, implement and support Patient Safety Consultation Teams.
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Baker and Norton offer an analysis for tackling medical error that, while not wrong, is very traditional in the policy solutions it recommends. The research priority should not be better measurement of error, but instead increased international cooperation to find solutions to existing problems. ⋯ Changing the culture of medicine is difficult. A model of governance that emphasizes quality and accountability may be a mechanism for developing a culture within medicine that reduces error and improves patient safety.