在疾病和死亡率会议上讨论医疗错误
Edgar Pierluissi1, Melissa A Fischer, Andre R Campbell
1San Francisco Veterans Affairs Medical Center, San Francisco,California, USA. epierluissi@co.sanmateo.ca.us
在外科住院计划的发病率和死亡率会议中,比内科计划更频繁地讨论不良事件和错误. 这两个专业都错过了模型错误识别和讨论的机会.
科学领域:
- 医学教育 医学教育
- 患者安全 患者安全
- 改善医疗保健质量 改善医疗保健质量
背景情况:
- 发病率和死亡率 (M&M) 会议对于住院培训至关重要,旨在通过讨论不良事件和医疗错误来改善患者护理.
- 关于M&M会议在实现其教育目标方面的有效性仍未得到充分研究.
研究的目的:
- 评估在M&M会议上提出的不良事件和错误的频率.
- 要确定这些错误是否被讨论并归因于它们的原因.
- 为了比较内部医学和外科住院计划之间的这些实践.
主要方法:
- 采用了前性调查设计,利用训练有素的医生观察员.
- 在2000年7月至2001年4月期间,从4家美国学术医院的内部医学和外科手术课程的332次M&M会议案例演示中收集了数据.
- 关键指标包括不良事件/错误呈现的频率,错误讨论和错误归因.
主要成果:
- 外科M&M会议的不良事件 (72%) 和错误 (42%) 比内科 (37%和18%) 更频繁.
- 与手术 (77%) 相比,在内部医学中讨论导致不良事件的错误较少 (48%).
- 将错误归因于特定原因在内科 (38%) 和外科手术 (79%) 中明显较低.
结论:
- 内部医学实习计划可能不会经常讨论不良事件和错误,质疑它们在这个领域的有效性.
- 虽然手术课程展示了更频繁的讨论和错误的归因,但这两个专业的教师错过了模拟错误识别和公开讨论的机会.
- 在M&M会议中需要改进策略,以促进明确错误的承认和讨论.
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