Promoting Patient Safety and Preventing Medical Error in Emergency Departments

An estimated 108,000 people die each year from potentially preventable iatrogenic injury. One in 50 hospitalized patients experiences a preventable adverse event. Up to 3% of these injuries and events take place in emergency departments. With long and detailed training, morbidity and mortality conferences, and an emphasis on practitioner responsibility, medicine has traditionally faced the challenges of medical error and patient safety through an approach focused almost exclusively on individual practitioners. Yet no matter how well trained and how careful health care providers are, individuals will make mistakes because they are human. In general medicine, the study of adverse drug events has led the way to new methods of error detection and error prevention. A combination of chart reviews, incident logs, observation, and peer solicitation has provided a quantitative tool to demonstrate the effectiveness of interventions such as computer order entry and pharmacist order review. In emergency medicine (EM), error detection has focused on subjects of high liability: missed myocardial infarctions, missed appendicitis, and misreading of radiographs. Some system-level efforts in error prevention have focused on teamwork, on strengthening communication between pharmacists and emergency physicians, on automating drug dosing and distribution, and on rationalizing shifts. This article reviews the definitions, detection, and presentation of error in medicine and EM. Based on review of the current literature, recommendations are offered to enhance the likelihood of reduction of error in EM practice.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74930/1/j.1553-2712.2000.tb00466.x.pd

Use of Blood Products for Elective Surgery in 43 European Hospitals

The objective of this study was to assess the use of blood products and artificial colloids in six commonly performed elective surgical procedures in 43 teaching hospitals in 10 European countries. 7,195 patient data were analysed. For each product wide differences were found between hospitals, both in the proportion of patients transfused and the amount of product used for the same patient category. Adjustment for age, gender, preoperative haematocrit and blood loss, left major differences among hospitals in patient red unit transfusion. Hospitals in the Mediterranean area used less albumin and artificial colloids and more autotransfusion than those of central-northern Europe. The reasons for perioperative red cell transfusion were stated in the patient's medical record for 23% of patients. The ratio of preoperative blood request to transfusion was maximal in cholecystectomy, where it exceeded 10. The documentation of blood request and transfusion, and of transfusion complications in medical records, did not fully agree with that in the transfusion service in 49, 53 and 92% of the hospitals, respectively. The wide differences in blood product used for the same patient category were due to a variety of causes of which only some could be explained by the clinical factors taken into account. This suggests that consensus conferences and guidelines have so far had a limited impact on transfusion practice in many clinical units, even in teaching environments