Error identification, disclosure, and reporting: Practice patterns of three emergency medicine provider types
Error identification, disclosure, and reporting: Practice patterns of three emergency medicine provider types
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DOI：
10.1197/j.aem.2003.08.020
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发表时间：
2004-02-01
影响因子：
4.4
通讯作者：
Hooker, J
中科院分区：
文献类型：
--
作者：
Hobgood, C;Xie, JP;Hooker, J
目标：收集初步数据，了解三种主要类型的急诊医学 (EM) 提供者：医生、护士 (RN) 和院外人员 (EMT) 在错误识别、披露和报告方面的差异。方法：急诊科 (ED) 提供者的方便样本完成了一项简短的调查，旨在评估错误频率、披露和报告实践以及基于错误的讨论和教育活动。结果：116 名受试者参与：41 名 EMT（35%）、33 名注册护士（28%）和 42 名医生（36%）。 45% 的 EMT、56% 的 RN 和 21% 的医生在上一年没有发现临床错误。当发现错误时，医生通过与注册护士 (58%)、患者 (13%)、药房 (35%) 和主治医生 (35%) 的对话来了解错误。对于已知的错误，所有提供者都同样不可能通知照顾患者的团队。向患者披露的信息有限，并且因提供者类型而异（19% 的急救人员、23% 的注册护士和 74% 的医生）。披露教育很少见，任何类型的提供者中只有不到 15% 接受此类指导。然而，59% 的医生观察到另一家提供商向患者披露了错误。错误讨论很普遍，所有提供商都表示他们讨论了自己以及其他人的错误。结论：本研究表明，错误识别、披露和报告对急诊科护理服务团队的所有成员提出了挑战。为了进一步将急诊室转变为高可靠性组织，需要针对提供者进行教育和加强团队合作培训。
Objectives: To gather preliminary data on how the three major types of emergency medicine (EM) providers, physicians, nurses (RNs), and out-of-hospital personnel (EMTs), differ in error identification, disclosure, and reporting. Methods: A convenience sample of emergency department (ED) providers completed a brief survey designed to evaluate error frequency, disclosure, and reporting practices as well as error-based discussion and educational activities. Results: One hundred sixteen subjects participated: 41 EMTs (35%), 33 RNs (28%), and 42 physicians (36%). Forty-five percent of EMTs, 56% of RNs, and 21% of physicians identified no clinical errors during the preceding year. When errors were identified, physicians learned of them via dialogue with RNs (58%), patients (13%), pharmacy (35%), and attending physicians (35%). For known errors, all providers were equally unlikely to inform the team caring for the patient. Disclosure to patients was limited and varied by provider type (19% EMTs, 23% RNs, and 74% physicians). Disclosure education was rare, with less than or equal to15% of any provider type receiving such instruction. Yet, 59% of physicians had observed another provider disclose an error to a patient. Error discussions are widespread, with all providers indicating they discussed their own as well as the errors of others. Conclusions: This study suggests that error identification, disclosure, and reporting challenge all members of the ED care delivery team. Provider-specific education and enhanced teamwork training will be required to further the transformation of the ED into a high-reliability organization.