Learning from Errors

The authors of this chapter have worked in emergency care in 5 countries on 4 continents in the past 9 years. In their experience, acute care anywhere in the world shares two main features; strong teamwork and tremendous mental, physical, and psychological stress. The significant workload, both on individual and team levels, render the care system vulnerable to human errors, which can unfortunately be detrimental to patients and staff alike. Due to the commonalities it is not surprising that health care professionals tend to make similar mistakes irrespective of economic, cultural, religious aspect or healthcare settings. We opine that mistakes are not necessarily and exclusively bad things, but invaluable opportunities for improvement. In this chapter, the authors aim to introduce the concept of learning from errors to the readers. Numerous studies and books have already been published on the subject, so anyone could rightfully ask, why read another study? The answer is straightforward, unlike other articles, this chapter invites the reader to work together with the authors through a real-world case. The text will guide the reader through the topic painlessly in a step-by-step fashion offering plenty of opportunity to practice and reflect on the newly acquired knowledge. Global healthcare is facing significant changes these days. Learning from errors may be the initial step to help move away from the blame and shame culture and build a new system which should be based on solid partnership and respect between patients and carers. Such a new, supportive and compassionate system could provide higher quality care and at the same time, protect practitioners from burnout and stress ensuring that healthcare jobs are not only work but a life-long fulfilling career

Antibiotics administered within 1 hour to adult emergency department patients screened positive for sepsis: a systematic review

Objective The 2018 Surviving Sepsis Campaign update recommended instigating the Sepsis-6 bundle within 1 h; however, the supporting evidence is weak. The objective was to systematically review the literature to determine whether there is mortality benefit (hospital or 28/30-day survival) associated with administration of antibiotics <1 h to adult emergency department (ED) patients screened positive for sepsis using systemic inflammatory response system criteria. Methods A systematic review and meta-analysis were conducted. Embase, CINAHL, Medline, Pubmed, Cochrane Library and grey literature were searched for articles published between 2012 and 2019. Results From 232 identified articles, seven met the inclusion criteria. Due to the small number of articles that fit the inclusion criteria and the considerable heterogeneity (I2 = 92.6%, P < 0.001), only the results of the systematic review are reported. Three of the seven studies demonstrated survival benefit for patients who screened positive for sepsis who were administered antibiotics ≤1 h after presentation to the ED. Four studies reported no statistically significant improvement in survival associated with administration of antibiotics within 1 h of ED presentation. Interestingly, two studies reported worse outcomes associated with early administration of antibiotics in patients with low acuity sepsis. Conclusion There is equivocal evidence of in-hospital or 28/30-day survival benefit associated with antibiotics administered ≤1 h after presentation to the ED for patients who screened positive for sepsis. Further research is needed to identify the exact patient group, which would truly benefit from initiation of antibiotics <1 h after ED presentation