Medical errors

In “Physician Burnout Calls for Legal Intervention” (November-December 2019), Sharona Hoffman calls for a “requirement” in the form of a “mandate that health care employers measure physician wellness using the [Maslach Burnout Inventory] (or another reliable tool) and report outcomes to [the Centers for Medicare and Medicaid Services]” (p. 9). Such a requirement would be unlawful under the Americans with Disabilities Act’s rules on prohibited medical examinations of employees.

Sharona Hoffman’s response to my letter states “employers may require periodic job-related medical examinations of all employees ‘in positions affecting public safety.’ As I argued in my commentary, doctors, to whom patients entrust their health every day, have safety-critical jobs.”

This comparison is inapt. As Ilene N. Moore, Screening Older Physicians for Cognitive Impairment: Justifiable or Discriminatory, 28 HEALTH MATRIX 95, 140 (2018) recently explained: “any interpretation suggesting that that physicians are in a position affecting public safety is not supported by the statutory language of the ADA, the EEOC Enforcement Guidance, or EEOC correspondence. Only one federal law defines some physicians as public safety officers: physicians who serve as part of a public rescue squad or ambulance as defined by the Omnibus Crime Control and Safe Streets Act of 1968.” (internal citations omitted).

I have three concerns about the description of central venous catheterization in the video by Graham et al.(May 24 issue). 1 First, it is misleading to describe the risk of hemothorax as “not applicable” when the internal jugular approach is used, since hemothorax is a known ...

However, such differences between countries may be due more to differences in the medical systems rather than differences in the quality of patient care. The United States has a very different medical environment, partly because of the highly litigious nature of US culture. 2 The fear of being sued may reduce the incidence of hindsight bias3 in US studies, since physicians may order more tests than are strictly necessary, which makes it more difficult for researchers such as Baker and associates to second-guess their decisions.

At The Johns Hopkins Hospital (JHH), the patient safety committee created a safety program that focused on encouraging staff in selected units to identify and eliminate potential errors in the patient care environment. As part of this program, senior hospital executives each adopted an intensive care unit and worked with the unit staff to identify issues and to empower staff to address safety issues. JHH PATIENT SAFETY PROGRAM: The program consisted of eight steps, which together require six months for implementation: (1) conduct a culture survey; (2) educate staff on the science of safety; (3) identify staff safety concerns through a staff safety survey; (4) implement the senior executive adopt-a-work unit program; (5) implement improvements; (6-7) document results, share stories, and disseminate results; and (8) resurvey staff. The senior executive adopt-a-work unit program was successful in identifying and eliminating hazards to patient safety and in creating a culture of safety....

Risk is defined as the probability of a specific adverse event occurring within a specific period, while Quantitative risk assessment (QRA) is the development of a quantitative estimate of risk based on engineering evaluation and mathematical techniques by combining estimate of incident consequences and frequencies. In view of the increase in the use of railways as the mode of transportation for hazardous materials throughout the world, the associated risk analysis should be taken into concern. In this study, the failure frequency of the transportation of ammonia from the Petronas fertilizers Kedah (PFK) plant in Gurun (Northern part of Peninsular Malaysia), to the Chemical Company Malaysia (CCM) fertilizer's facilities in Port Klang (South-western part of Peninsular Malaysia) was evaluated by incorporating the human error assessment. The study highlighted the importance of human error contributions in the failure frequency analysis and its impact on the selected failure scenarios. Besides, it also shows that the application of the human error assessment and reduction technique (HEART), which is a useful human reliability analysis tool, should be used in parallel with the fuzzy arithmetic approach to reduce the uncertainties involved in the estimation of human error probabilities, and hence, to reduce the likelihood of incorrect risks estimates being assessed. The results suggested that the commonly applied approach in quantitative risk assessments, which only consider equipment failures in the failure frequency estimations, are clearly an underestimate of the potential causes of failures leading to hazardous material releases, and hence, the calculated risks based do not reflect the actual risks. © 2008 American Institute of Chemical Engineers Process Saf Prog, 2009

To describe and classify process errors and preventable adverse events that occur from medical care in outpatient primary care settings. Systematic review and synthesis of the medical literature. We searched MEDLINE and the Cochrane Library from 1965 through March 2001 with the MESH term medical errors, modified by adding family practice, primary health care, physicians/family, or ambulatory care and limited the search to English-language publications. Published bibliographies and Web sites from patient safety and primary care organizations were also reviewed for unpublished reports, presentations, and leads to other sites, journals, or investigators with relevant work. Additional papers were identified from the references of the papers reviewed and from seminal papers in the field. Process errors and preventable adverse events. Four original research studies directly studied and described medical errors and adverse events in primary care, and 3 other studies peripherally addressed ...

Aim-To determine the gender using mental foramen as landmark on a panoramic radiographs in selected North Gujarat population. Objective-1. To evaluate and compare the superior border of mental foramen to lower border of mandible(S-L) and inferior border of mental foramen to lower border of mandible(I-L) value in males and females bilaterally. 2. To compare the S-L and I-L between right and left side in males and female 3. To utilize above measurements for gender determination. Materials and Method-Sixty panoramic radiographs were selected for the analysis of mental foramen. Tangents were drawn through the superior and inferior borders of the foramen (S-L and I-L respectively) and perpendicular from the tangents to the lower border of the mandible bilaterally. Digital verniar caliper was used for the distance measurement from S-L and I-L. The data obtained was tabulated and subjected to statistical analysis. Result-The analyzed data of study showed that the mean values of comparison of S-L as well as I-L in males and females were significantly higher in males as compared to females. The comparison of SL and IL on right and left side in the same patient was without any significant difference. Conclusion-The results of present study concluded a definite sexual dimorphism in the position of the mental foramen from the base of the mandible; this method can applied in mass disaster where the fragments of mandible are available.

Since its publication in 2008, SQUIRE (Standards for Quality Improvement Reporting Excellence) has contributed to the completeness and transparency of reporting of quality improvement work, providing guidance to authors and reviewers of reports on healthcare improvement work. In the interim, enormous growth has occurred in understanding factors that influence the success, and failure, of healthcare improvement efforts. Progress has been particularly strong in three areas: the understanding of the theoretical basis for improvement work; the impact of contextual factors on outcomes; and the development of methodologies for studying improvement work. Consequently, there is now a need to revise the original publication guidelines. To reflect the breadth of knowledge and experience in the field, we solicited input from a wide variety of authors, editors and improvement professionals during the guideline revision process. This Explanation and Elaboration document (E&E) is a companion to t...