Hello, modiano-ga!
Well, a question that I thought would be relatively easy to answer
proved to be surprisingly tough! I presumed there would be a readily
available list of the top medical errors, but there was nothing of the
sort. I also assumed there would be numerous studies showing the
efficacy of simulated training and the proven reduction of medical
errors in the clinical setting. There were only two!
There was a wealth of information pertaining to the existence of
medical errors as a very serious problem. But, when it came to
identifying the major causes of medical error, it was a matter of
piecing information together from numerous sources.
There was also no shortage of information pertaining to training
programs for medical students and physicians, including simulated
surgery, videotaping of mock procedures, etc. While the research
suggests that medical personnel learned from, valued the training and
posted positive results on the simulator, there was little information
regarding the carryover of results into an actual medical setting. In
other words, I could find no studies that stated, for example -
"twenty physicians trained on the cardiovascular surgical simulator,
performed brilliantly, and five years later, those same physicians
have seen a x% reduction in medical errors." Only two studies recorded
reduced clinical errors.
I don't know if this information is a positive revelation for you or
not. At the very least, it points to the need for follow-up studies to
prove that various types of simulated training can have a positive
carryover into the medical setting.
========================
DEFINING MEDICAL ERRORS
========================
"The IOM defines medical error as "the failure to complete a planned
action as intended or the use of a wrong plan to achieve an aim." An
adverse event is defined as "an injury caused by medical management
rather than by the underlying disease or condition of the patient."
Some adverse events are not preventable and they reflect the risk
associated with treatment, such as a life-threatening allergic
reaction to a drug when the patient had no known allergies to it.
However, the patient who receives an antibiotic to which he or she is
known to be allergic, goes into anaphylactic shock, and dies,
represents a preventable adverse event."
"Most people believe that medical errors usually involve drugs, such
as a patient getting the wrong prescription or dosage, or mishandled
surgeries, such as amputation of the wrong limb. However, there are
many other types of medical errors, including:
* Diagnostic error, such as misdiagnosis leading to an incorrect
choice of therapy, failure to use an indicated diagnostic test,
misinterpretation of test results, and failure to act on abnormal
results.
* Equipment failure, such as defibrillators with dead batteries or
intravenous pumps whose valves are easily dislodged or bumped, causing
increased doses of medication over too short a period.
* Infections, such as nosocomial and post-surgical wound infections.
* Blood transfusion-related injuries, such as giving a patient the
blood of the incorrect type.
* Misinterpretation of other medical orders, such as failing to give a
patient a salt-free meal, as ordered by a physician.
From "Medical Errors: The Scope of the Problem. Fact sheet,
Publication No. AHRQ 00-P037. Agency for Healthcare Research and
Quality, Rockville, MD. http://www.ahrq.gov/qual/errback.htm
===
"The human cost of medical errors is high. Based on the findings of
one major study, medical errors kill some 44,000 people in U.S.
hospitals each year. Another study puts the number much higher, at
98,000. Even using the lower estimate, more people die from medical
mistakes each year than from highway accidents, breast cancer, or
AIDS.
Moreover, while errors may be more easily detected in hospitals, they
afflict every health care setting: day-surgery and outpatient clinics,
retail pharmacies, nursing homes, as well as home care. Deaths from
medication errors that take place both in and out of hospitals - more
than 7,000 annually - exceed those from workplace injuries."
From "Preventing Death and Injury From Medical Errors Requires
Dramatic, System-Wide Changes." National Academies (1999)
http://www4.nationalacademies.org/news.nsf/isbn/0309068371?OpenDocument
=====================================
GENERAL INFORMATION ON TYPE OF ERRORS
=====================================
"In a recent overview of 11 studies on the frequency and nature of
medical errors in primary care, medical error rates ranged from 5 to
80 errors per 100,000 visits. Errors related to delayed or missed
diagnosis were most common, ranging from 26% to 78% of identified
errors. Treatment errors comprised the second most common category,
accounting for 11% to 42% of identified errors. The causes of these
errors were often multiple and remained unidentified in up to 50% of
cases. The marked diversity in the findings reflected the varied
definitions of errors and methods of detection."
"A recent study of US family practitioners that was designed to
develop a taxonomy of errors that are likely to occur in primary care
practices gives an idea of the relative frequencies of different types
of errors) Forty-two physicians voluntarily provided 344 error
reports. Of these, 330 were deemed true errors; 72 occurred in the
outpatient setting. Most errors were due to errors in lab or testing
processes (27% information management or charting (23%), medication
therapy (18%), and knowledge errors on the part of the physician
(13%). The physicians reported that 44% of their errors led to adverse
events, including 1 death. A similar study of a multinational group of
general practitioners had similar results."
From "Reducing medical errors in primary care: medical errors come in
all shapes and sizes and stem from a variety of causes," by Craig R.
Keenan, Kwabena Adubofour, Ashok V. Daftary. Patient Care, (Dec, 2003)
http://216.239.53.104/search?q=cache:UAfCe7O-MgwJ:www.findarticles.com/cf_dls/m3233/12_37/112314608/p1/article.jhtml+Medical+training+to+reduce+errors&hl=en
(This is a "cached" link. If it is not highlighted in my answer,
simply copy and paste the URL into your browser to read the full
article)
===
A report from the Robert Graham Center analyzed more than 50,000
claims from the Physician Insurers Association of America malpractice
claims database. The results highlight the following:
* "The research focuses on the actual location where people are most
frequently harmed: the outpatient setting, not in hospitals."
Another Overview of Causes
============================
"The JOURNAL of the AMERICAN MEDICAL ASSOCIATION (JAMA) Vol 284, No 4,
July 26th 2000 article written by Dr Barbara Starfield, MD, MPH, of
the Johns Hopkins School of Hygiene and Public Health, shows that
medical errors may be the third leading cause of death in the United
States.
The report apparently shows there are:
2,000 deaths/year from unnecessary surgery;
7,000 deaths/year from medication errors in hospitals;
20,000 deaths/year from other errors in hospitals;
80,000 deaths/year from infections in hospitals;
106,000 deaths/year from non-error, adverse effects of medications
these total up to 225,000 deaths per year in the US from iatrogenic
causes which ranks these deaths as the # 3 killer. Iatrogenic is a
term used when a patient dies as a direct result of treatments by a
physician, whether it is from misdiagnosis of the ailment or from
adverse drug reactions used to treat the illness. (drug reactions are
the most common cause)."
From the CancerCure website:
http://www.cancure.org/medical_errors.htm
===================
DIAGNOSTIC ERRORS
===================
* "Diagnostic errors accounted for more than one-third of the claims."
"The underlying cause "diagnostic error" alone accounted for over
one-third of claims. The category "diagnostic error" doesn't give us
enough information to fix the problems. This category is most likely
not about bad doctors and more likely about doctors making decisions
with poor support systems and information.
"For example, it doesn't tell us whether the wrong diagnoses resulted
from a lab report that did not reach the physician, a consultant note
filed in the wrong patient's chart or if the physician made the wrong
decision that could have been avoided with better training."
=================
RECORDS PROBLEMS
=================
"Problems with records" was associated with errors that hurt a lot of
people, and these harms were fairly evenly distributed across the
outcome severity categories (low, moderate and high severity, and
death).
======================================
FAULTY COMMUNICATION BETWEEN PROVIDERS
=======================================
"Problems with "communication between providers" contributed to more
high severity outcomes and death. How your doctor is equipped to
manage your medical records and talk with other doctors can protect
you from errors. These two contributing factors suggest that frequent
errors in primary care that are thought to be trivial can contribute
to bad health outcomes for patients and should not be ignored."
From "Outside View: To prevent medical errors," by Dr. Robert L.
Phillips Jr. United Press International. (April 2, 2004)
http://washingtontimes.com/upi-breaking/20040401-041120-3279r.htm
and
"Malpractice Claim Reports Can Help Direct Prevention of Medical
Errors, Study Says." American Academy of Family Physician. April 1,
2004
http://www.aafp.org/x26865.xml
=======================
DRUG/MEDICATION ERRORS
=======================
"Drugs have been found to be among the most common causes of medical
injury. In the Harvard study, 19.4 percent of the injuries detected
were related to the use of drugs, while the Andrews study determined
that 9.3 percent of injuries were medication-related."
From "Medical Error and Patient Injury: Costly and Often Preventable."
AARP Research.
http://216.239.57.104/search?q=cache:bfzbgWKdRoUJ:research.aarp.org/health/ib35_medical_1.html+major+causes+of+medical+errors&hl=en
(to access this article, please copy and paste the article title and
click on the "cached" version, or copy and paste the URL into your
browser)
=============
SYSTEM FLAWS
=============
"The majority of medical errors do not result from individual
recklessness, the report says, but from basic flaws in the way the
health system is organized. Stocking patient-care units in hospitals,
for example, with certain full-strength drugs - even though they are
toxic unless diluted - has resulted in deadly mistakes. And illegible
writing in medical records has resulted in administration of a drug
for which the patient has a known allergy."
From "Preventing Death and Injury From Medical Errors Requires
Dramatic, System-Wide Changes." National Academies (1999)
http://www4.nationalacademies.org/news.nsf/isbn/0309068371?OpenDocument
==
"Findings from several studies of large numbers of hospitalized
patients indicate that each year a million or more people are injured
and as many as 100,000 die as a result of errors in their care."
"..errors are seldom due to carelessness or lack of trying hard
enough. More commonly, errors are caused by faulty systems, processes
and conditions that lead people to make mistakes. They can be
prevented by designing systems that make it hard for people to do
something wrong and easy to do it right."
From "CONCERNING PATIENT SAFETY AND MEDICAL ERRORS." Statement by
Lucian Leape, M.D. before the Committee on Health, Education, Labor
and Pensions. U.S. Senate (1/25/2000)
http://www4.nationalacademies.org/ocga/testimon.nsf/0/7855d392199e399685256873006dd790?OpenDocument
===================
INADEQUATE STAFFING
===================
"More than one-third of practicing physicians and 40 percent of the
public say they or a family member have experienced a medical error,
according to a survey reported Dec. 12 in the New England Journal of
Medicine. And, while the two groups diverged on possible causes and
solutions, both ranked shortages of nurses; and overwork, stress and
fatigue among health care workers as "very important" causes of
errors."
"Specifically, the survey found that more than 53 percent of
physicians and 65 percent of the public cited understaffing of nursing
in hospitals as a factor in errors, while 50 percent and 70 percent of
physicians and the public, respectfully, blamed errors on overworked,
stressed or fatigued health care workers. The survey was conducted
last spring by researchers at the Henry J. Kaiser Family Foundation
and the Harvard School of Public Health."
"This study provides more evidence of the impact of nurses' working
conditions on patients," said ANA President Barbara Blakeney, MS,
APRN,BC, ANP. "The results point to the fact that medical mistakes are
common and that both physicians and the public see inadequate nurse
staffing as a significant cause of errors."
From "Harvard University Study Identifies Inadequate Nurse Staffing as
A Major Factor in Medical Errors." American Nurses Association. (Dec.
16, 2002)
http://www.nursingworld.org/pressrel/2002/pr1216.htm
Additional Information
======================
You might want to order the following books if you have time before
your presentation:
"Medical Error: What Do We Know? What Do We Do Now?
http://www.med.umich.edu/opm/newspage/2002/medbook.htm
(see ordering information at bottom of article)
"Internal Bleeding: The Truth Behind America's Terrifying Epidemic of
Medical Mistakes," by Robert Wachter and Kaveh Shojania
http://www.book.nu/1590710169
==================
TRAINING PROGRAMS
==================
Though there is a lot of information on medical training (primarily
medical simulation) there is very little published on the results as
applied to reduced medical errors. I found only one study that
actually mentioned a reduction of medical errors. One other study
revealed a marked increase in confidence of personnel conducting
medical trials.
Positive Results from the MedTeam Training Curriculum
=======================================================
"The MedTeams curriculum teaches behaviors that are applicable to the
healthcare workplace and are anchored in real world problems. The core
of the training is 41 well-defined behaviors that constitute the
process of teamwork. The training takes 8 hours, and is augmented by a
video depicting examples of good and poor teamwork, practical
exercises, and discussion. Practicums, coaching, mentoring, and
teamwork review sessions subsequently take place in the emergency
department to further instruct and reinforce teamwork behaviors in the
operational setting."
"But for now, let me turn to the impact of our training on events in
the ER. We conducted an experiment involving nine teaching and
community hospitals divided into experimental and control groups.5 The
experimental group received the MedTeams training. The control group
allowed us to evaluate improvements occurring in the experimental
group. Three outcome constructs were assessed: team behaviors,
attitudes and opinions, and ED performance. Improvements were obtained
in the experimental group for six out of the seven key measures
assessed. The quality of team behaviors improved, workload was not
increased by practicing teamwork, staff attitudes towards teamwork
were enhanced, preparation of patients admitted from the ER improved,
and the proportion of highly satisfied patients increased."
** The most important finding from the validation was that clinical
errors were substantially and significantly reduced. A clinical error
was defined as any clinical task that actually or potentially put a
patient at risk. These errors were witnessed by a specially trained ER
nurse or physician observing cases for the purpose of rating teamwork
behaviors.
" An example of a reported error occurred during a resuscitation. A
burn patient received duplicate administrations of intravenous
morphine when two nurses independently administered the drug after a
physician gave a verbal order. The staff recognized the overdose when
the patient's breathing slowed, at which point they intervened and the
patient recovered. A check-back for a verbal medical order, a teamwork
behavior taught in MedTeams, would have avoided or "captured" this
error."
Read "Panel 2: Broad-based Systems Approaches - Creating Complementary
Roles for Behavioral Solutions and Technology Applications to Patient
Safety." Testimony of Robert L Wears, MD, MS, Department of Emergency
Medicine University of Florida; Robert Simon, EdD, CPE, Chief
Scientist, Crew Performance Group, Dynamics Research Corporation; and
the MedTeams Consortium* (Sept 2000)
http://www.quic.gov/summit/wwears.htm
Simulated sigmoidoscopy result in fewer directional errors on actual patients
===============================================================================
"In a small randomized controlled trial enrolling 10 residents, Tuggy
and colleagues found residents who trained for flexible sigmoidoscopy
using a virtual reality simulator were faster, visualized a greater
portion of the colon, and made fewer directional errors in actual
patients.
From "Chapter 45: Simulator-Based Training and Patient Safety."
http://www.ahrq.gov/clinic/ptsafety/pdf/chap45.pdf
Increased Confidence in Clinical Trial Setting after Simulation Training
=========================================================================
"Duke University Medical Center researchers have demonstrated that
training research coordinators on a human simulator prior to a complex
clinical trial can significantly improve the coordinators' confidence
in their abilities. Since the researchers believe that confidence is a
central element in competence, they said that the routine use of such
simulators could not only lead to the collection of higher quality
data during a trial, but can also have an important impact on
improving patient safety."
"According to Taekman, when ranked on a scale of one to ten, with ten
being the most confident, the coordinators who participated saw their
overall average confidence score increase from 5.7 to 8.12."
"While all three domains of learning saw dramatic increases after
simulator training, the psychomotor area saw the greatest relative
improvement, from 4.83 to 8.1. The affective domain increased from
6.13 to 8.17 and the cognitive domain increased from 6.17 to 8.03."
"We fully believe that simulation training could be the wave of the
future, especially after seeing the results of this study," Taekman
said. "The current approach to training coordinators fails to take
advantage of adult learning theory, which has shown that interactivity
is a superior method for teaching medical professionals."
"In terms of the learning process, the simulator provides the next
best thing than actually being at the bedside." Taekman continued.
"The simulator allows learners to hone their skills before coming in
contact with patients, thereby shortening the learning curve."
From "Patient Simulator Improves Performance Of Clinical Trial
Coordinators. Duke Med News. (10/14/2003)
http://dukemednews.duke.edu/news/article.php?id=7099
Patient Safety Team Training points to potential for reduced clinical
errors ============================================================================
"VHA offers its member hospitals Patient Safety Team Training, a
product focused on improving patient safety, patient satisfaction, and
performance in the emergency or labor delivery departments. VHA's
Patient Safety Team Training uses proven methods based on aviation
crew resource management techniques employed in that industry.
Grounded in two decades of research and development, this training
process was evaluated at 12 leading health care organizations over two
years.
** Effectiveness results included fewer observed clinical errors,
minimized litigation costs, and enhanced ability to achieve compliance
with patient safety standards of the Joint Commission for
Accreditation of Healthcare Organizations as well as with the IOM's
1999 patient safety recommendations."
(I could find no documentation for the above statement on reduced clinical errors)
"Under this program, a VHA physician and nurse who have expertise in
team training implementation in the high-performance, high-stress care
environment first conduct an on-site assessment of an organization?s
readiness. They then conduct "train the trainer"sessions where select
physicians and nurses in the organization learn to present the core
curriculum to all staff members, bring about a culture change in their
department, and reinforce team work behaviors using facilitated
leadership and coaching."
From "Reducing Medical Errors: A Review of Innovative Strategies to
Improve Patient Safety." Subcommittee on Health. (May 8, 2002)
http://energycommerce.house.gov/107/hearings/05082002Hearing557/Freeman955.htm
Simulation studies which demonstrate improved skills, but do not
measure error reduction in the medical setting:
===============================================================================
Background:
"We initiated a teaching module utilizing a human simulator midway
through 2001-2002 to improve student skills specific to the evaluation
of patients in shock during a required clerkship in surgery for 4th
year medical students. We tested the hypothesis that student skills
would improve after implementation of this module and identified
factors that predicted student performance."
Conclusion:
"In a clerkship that already emphasized faculty facilitated case-based
learning, the use of a teaching module employing a human simulator
significantly improved test scores. This study supports the efficacy
of human simulators to improve student skills related to the
management of complex critically ill patients."
From "Effective Use of Human Simulators in Surgical Education," by
Mordechai Bermann, MD UMDNJ (2003)
http://www.anestech.org/Publications/IMMS_2003/sta46.html
===
Introduction:
"To date, few studies have attempted to quantify human performance
during simulation training. This study used training evaluation from
the applied psychology literature to assess the effectiveness of
simulator training in increasing residents performance. We examined
residents level of confidence, knowledge, attitudes and performance
during a 3-day pre-clinical simulator course. The variables have been
identified as critical indices of effectiveness in training
intervention."
Results:
"Subjects responses were analyzed to examine changes in residents
levels of confidence, knowledge, and reactions as a function of time
on the simulator. Residents level of confidence on trained tasks
increased dramatically, while confidence in non-trained tasks remained
steady. Knowledge test results showed an increase in the residents
scores and an increased level in knowledge for trained tasks. Trainees
were highly motivated. They perceived the simulator training to be
extremely useful. Additionally, residents wished to have further
simulator training. Finally, evaluation of the videotaped scenarios
showed that residents recognition skills and critical decision making
improved while reaction time and number of errors were reduced."
From "Increasing Performance Through Simulator Training and Empirical
Evaluation," by Harold Doerr, M.D., Miquel A. Quinones1, Ph.D., Robert
L. Dipboye1, Ph.D., Burdett a Dunbar,M.D.
http://www.anestech.org/Publications/Annual_2000/Doerr.html
==
"As part of an ongoing study at Rush Presbyterian St. Luke's Medical
Center, residents who practised sigmoidoscopies on Immersion Medical's
simulators demonstrated a statistically significant 75 percent
increase in overall competency scores. This study validates the use of
Immersion Medical's AccuTouch Endoscopy Simulator with Flexible
Sigmoidoscopy module in reducing the number of patient-based
procedures required to achieve competency in performing flexible
sigmoidoscopy. A gastro-enterologist objectively scored the residents,
monitoring factors such as intubation, retroflexion, pathology, and
virtual patient discomfort."
"This study validates the use of medical simulators for training
doctors in conducting minimally invasive surgeries", stated Dr.
Michael Brown of Rush Presbyterian St. Luke's Medical Center.
"Immersion Medical's simulators are a more effective way of training
than the traditional methods, allowing residents to repeat difficult
procedures until they feel comfortable. Reducing the number of
procedure-related errors during the learning process translates into
safer patient care. This technology will have profound effects in
improving health care education at all levels."
From "Study proves medical simulators reduce number of patient-based
procedures required to learn endoscopy skills." Virtual Medical World.
(Dec. 2002) http://www.hoise.com/vmw/03/articles/vmw/LV-VM-01-03-8.html
===
Medical students displayed greater detection of breast tumors in the
dynamic, variable-lump, silicone breast simulator after training.
However, there is still a need for this type of training to display a
transfer of results to the clinical setting.
"DYNAMIC SIMULATOR FOR TRAINING CLINICAL BREAST EXAMINATION Gregory J.
Gerling, Geb W. Thomas, Alicia M. Weissman, Edwin L. Dove
http://grok.ecn.uiowa.edu/Main/Publications/HFES_02_Final.pdf
===
Stanford has implemented a number of simulation training programs,
which are described below. Unfortunately, there is no follow-up data
on whether these programs have actually reduced errors in the medical
setting.
If you have time, you might want to call the Director of the Center
and ask if they have compiled any data:
David M. Gaba, M.D
Patient Safety Center of Inquiry (PSCI)
Anesthesia Service, 112A
VA Palo Alto Health Care System
3801 Miranda Avenue
Palo Alto, CA 94304
Voice: (650) 858 3938 Fax: (650) 849-0421 Email: gaba@stanford.edu
"Simulation Center for Crisis Management Training in Health Care - VA
Palo Alto Health Care System & Stanford University."
http://anesthesia.stanford.edu/VASimulator/
The Simulation Center:
http://anesthesia.stanford.edu/VASimulator/simcntr.htm
Anesthesia Crisis Resource Management (ACRM)
http://anesthesia.stanford.edu/VASimulator/acrm.htm
Criteria for ACRM-like Training
http://anesthesia.stanford.edu/VASimulator/ACRM_Criteria.htm
The Simulated Delivery Room (SDR)
http://anesthesia.stanford.edu/VASimulator/SDRE.htm
The MedSim-Eagle Patient Simulator
http://anesthesia.stanford.edu/VASimulator/sim.htm
Other types of Training (with no documentation of decrease error in the field)
========================
"Another way to enhance patient safety through early identification is
by implementing disease management programs. We have comprehensive
disease management programs in place for asthma, diabetes, high-risk
pregnancies and cardiovascular disease. In these programs, an
engagement model is used to contact all members affected by the
disease and help them manage their condition better. In these
programs, all patients are entered into a tracking database, which
allows us to develop error prevention information.
* Physicians receive training on best practices through problem-based
learning techniques, which is a familiar and accepted mode of
learning.
* "Outcomes to date for our asthma program show improved use of
appropriate medication and reduced emergency rooms use. In patients
with diabetes, the appropriate number of HgA1c tests are being ordered
and that members are getting the appropriate exams for feet, eyes,
etc."
From "HMSA's Program to Improve the Quality of Health Care by Reducing
Medical Errors and Increasing Patient Safety."
http://www.hmsa.com/about/quality/patient_safety.asp
==
Enhancing Communication Skills between physicians and patients is
touted as a method to reduce medical errors. However, there is no
mention of programs or outcome results.
From "Enhanced communication to reduce liability," by James W. Saxton,
Esq. & Maggie M. Finkelstein, Esq. Physicians News Digest. Published
November 2003
http://www.physiciansnews.com/business/1103saxton.html
===
"Diagnostic errors are the most difficult to prevent, and the most
devastating, according to Dr. Croskerry. Drawing on his psychology
background (a field in which he obtained a PhD before entering
medicine), Dr. Croskerry has developed a two-hour course for medical
students that has become part of the "Introduction to Clerkship"
program. Called Applied Cognitive Training in Acute Care Medicine, the
course teaches students how to be aware of their own thinking as they
approach a patient, and gives strategies for avoiding errors.
Dalhousie is the first medical school to introduce such a course,
though Dr. Croskerry hopes it will soon be standard across North
America."
From "Symposium Part of Larger Effort to Address Medical Error."
Connection. October/November 2001, Vol.8, No.6
http://communications.medicine.dal.ca/connection/junejuly2002/conn20027k.htm
SIMULATED TRAINING DOESN'T ALWAYS TRANSFER TO INCREASED COMPETENCY IN THE FIELD
===============================================================================
"Proficiency on a simulator does not ensure proficiency in clinical
settings. Simulator fidelity (ie, how accurately the simulator
replicates reality) is imperfect. It is much more difficult to
"re-create" a human being than to do so for, say, an airplane. This
limitation is illustrated by a study conducted by Sayre and
colleagues. They studied emergency medical technicians (EMT) who
learned intubation techniques on anesthesia mannequins. After
successfully intubating the mannequins 10 times, they were permitted
to intubate patients in the field, where their proficiency was only
53%. Other factors can inhibit optimum learning using simulation or
the applicability of learning to real practice. Other factors can
inhibit optimum learning using simulation or the applicability of
learning to real practice. Some participants may be more vigilant than
usual during simulator sessions. Others may be unable to "suspend
disbelief," may treat the simulationonly as a game, or act in a
cavalier fashion, knowing that the simulator is not a real patient.
Refinement of simulators to make them more sophisticated and life-like
may help to improve the quality of the training that simulators can
provide."
From "Chapter 45: Simulator-Based Training and Patient Safety."
http://www.ahrq.gov/clinic/ptsafety/pdf/chap45.pdf
ADDITIONAL READING
===================
A host of links to Simulation Articles: (which I cannot access)
http://www.harvardmedsim.org/Simulation%20references.htm
"Reducing Medical Errors: A Review of Innovative Strategies to Improve
Patient Safety." Subcommittee on Health (May 8, 2002)
http://energycommerce.house.gov/107/hearings/05082002Hearing557/print.htm
"Virtual training to reduce surgical errors." The Age (April 11 2003)
http://www.theage.com.au/articles/2003/04/11/1049567857521.html
"Chapter 2. Efforts to Reduce Medical Errors: AHRQ's Response to
Senate Committee on Appropriations Questions."
http://www.ahrq.gov/qual/pscongrpt/psini2.htm
==
I hope the information I have provided is useful. If it turns out
that I took your request about proven results too literally, and you
are happy with positive results before and after using a simulator
(but not necessarily in the clinical setting), please let me know and
I will certainly add more references. I came across many such reports,
but did not include them because they did not apply to real life
situations.
As usual, if you have need for further clarification of any sort,
please don't hesitate to ask. I will be happy to help if I can!
Sincerely,
umiat
Search Strategy
major causes of medical errors
top medical mistakes
training to avoid medical mistakes
training physicians to avoid medical errors
training to avoid medical mistakes
patient simulation and error prevention
does medical simulation reduce errors?
Medical training to reduce errors
diagnostic simulation to reduce medical errors
results of simulated medical training to reduce errors
increased medical performance after simulated training
decrease in medical errors after simulated training |
