A preliminary taxonomy of medical errors in family practice
A preliminary taxonomy of medical errors in family practice
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DOI：
10.1136/qhc.11.3.233
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发表时间：
2002-09-01
影响因子：
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通讯作者：
Grob, P
中科院分区：
文献类型：
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作者：
Dovey, SM;Meyers, DS;Grob, P
目的：建立初级保健医疗差错的初步分类。设计：定性分析，以确定计算机和纸张报告方法的随机对照试验期间报告的差错类别。设置：国家家庭实践和初级保健研究网络。参与者：家庭医生。主要结果测量：医疗差错类别，背景和后果。结果：42名医生提出了344份报告：284例（82.6%）由医疗保健系统功能障碍引起; 46例（13.4%）是由于知识或技能差距造成的错误; 14例（4.1%）是不良事件报告，而不是错误。主要的子类别是：管理失误（102; 30.9%的错误），调查失败（82; 24.8%），治疗实施失误（76; 23.0%），沟通不畅（19; 5.8%），支付系统问题（4; 1.2%）、临床任务执行错误（19; 5.8%）、错误治疗决定（14; 4.2%）和错误诊断（13; 3.9%）。大多数报告都是在报告者的实践中发现和发生的错误。受影响的患者年龄从8个月到100岁不等，男女都有，代表了美国所有主要种族。几乎一半的报告都是有不良后果的事件。10个错误导致患者入院治疗，1名患者dead.Conclusions：这种医疗错误分类，从自我报告的家庭医生在日常的临床实践中观察到的错误，强调在医疗保健过程中的问题，并承认医疗错误所产生的临床知识和技能的不足。在初级保健环境中最有效的患者安全策略需要比目前对用药错误的关注更广泛。
Objective: To develop a preliminary taxonomy of primary care medical errors.Design: Qualitative analysis to identify categories of error reported during a randomized controlled trial of computer and paper reporting methods.Setting: The National Network for Family Practice and Primary Care Research.Participants: Family physicians.Main outcome measures: Medical error category, context, and consequence.Results: Forty two physicians made 344 reports: 284 (82.6%) arose from healthcare systems dysfunction; 46 (13.4%) were errors due to gaps in knowledge or skills; and 14 (4.1%) were reports of adverse events, not errors. The main subcategories were: administrative failures (102; 30.9% of errors), investigation failures (82; 24.8%), treatment delivery lapses (76; 23.0%), miscommunication (19; 5.8%), payment systems problems (4; 1.2%), error in the execution of a clinical task (19; 5.8%), wrong treatment decision (14; 4.2%), and wrong diagnosis (13; 3.9%). Most reports were of errors that were recognized and occurred in reporters' practices. Affected patients ranged in age from 8 months to 100 years, were of both sexes, and represented all major US ethnic groups. Almost half the reports were of events which had adverse consequences. Ten errors resulted in patients being admitted to hospital and one patient died.Conclusions: This medical error taxonomy, developed from self-reports of errors observed by family physicians during their routine clinical practice, emphasizes problems in healthcare processes and acknowledges medical errors arising from shortfalls in clinical knowledge and skills. Patient safety strategies with most effect in primary care settings need to be broader than the current focus on medication errors.